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					 RPI Ambulance




Standard Operating Procedures
        May 30, 2011
Table of Contents
SOP 10-00 Organization and Structure ....................................................................... 6 
SOP 10-01 Mission Statement ...................................................................................... 7 
SOP 10-02 Qualification Procedures - Volunteer Personnel ..................................... 8 
  Application Procedures ....................................................................................................... 8 
  Orientation ............................................................................................................................ 8 
  Health and Safety ................................................................................................................. 8 
SOP 10-03 Operational Member Types...................................................................... 10 
  Introduction ........................................................................................................................ 10 
  Membership Requirements ............................................................................................... 10 
  Active - I Membership ....................................................................................................... 10 
  Active - II Membership ...................................................................................................... 10 
  Administrative Membership ............................................................................................. 10 
SOP 10-04 Training and Promotions ......................................................................... 12 
  Introduction ........................................................................................................................ 12 
  Training ............................................................................................................................... 12 
  Training Committee ........................................................................................................... 12 
  Back-up Training ............................................................................................................... 12 
  Trainers ............................................................................................................................... 12 
  Promotional Boards: Structure ........................................................................................ 13 
  Promotional Boards: Voting ............................................................................................. 14 
SOP 10-05 Observer .................................................................................................... 15 
  Functional Job Description ............................................................................................... 15 
     Observer ..................................................................................................................... 15 
     Orientation Member ................................................................................................... 15 
  Training ............................................................................................................................... 16 
     Ambulance Orientation Member ................................................................................ 16 
        Prerequisites ...................................................................................................... 16 
        Requirements .................................................................................................... 16 
SOP 10-06 Ambulance Attendant............................................................................... 17 
  Functional Job Description ............................................................................................... 17 
  Training ............................................................................................................................... 17 
     Prerequisites ............................................................................................................... 17 
     Promotion ................................................................................................................... 17 
SOP 10-07 Emergency Vehicle Operator Roles and Responsibilities .................... 18 
  Function Job Description .................................................................................................. 18 
     Introduction ................................................................................................................ 18 
     Definitions .................................................................................................................. 18 
     Driver Qualifications .................................................................................................. 18 
     General Driving Procedures ....................................................................................... 19 
     Emergency Driving Procedures .................................................................................. 19 
     Driver’s Duties ........................................................................................................... 19 
     Spotters ....................................................................................................................... 20 
     Back-Up Alarm .......................................................................................................... 21 
     Travel Limits .............................................................................................................. 21 
  Training ............................................................................................................................... 21 
     Back-up Driver ........................................................................................................... 21 
        Prerequisites ...................................................................................................... 21 
        Requirements .................................................................................................... 21 
     Driver .......................................................................................................................... 22 
        Prerequisites ...................................................................................................... 22 
        Requirements .................................................................................................... 22 
     Driver Trainer ............................................................................................................. 22 
        Prerequisites ...................................................................................................... 22 
        Requirements .................................................................................................... 22 
SOP 10-08 Crew Chief ................................................................................................. 23 
  Function Job Description .................................................................................................. 23 
     Introduction ................................................................................................................ 23 
     Qualifications ............................................................................................................. 23 
     General Procedures ..................................................................................................... 23 
     Crew Chief’s Duties ................................................................................................... 24 
  Training ............................................................................................................................... 25 
     Back-up Crew Chief ................................................................................................... 26 
        Prerequisites ...................................................................................................... 26 
        Requirements .................................................................................................... 26 
     Ambulance Crew Chief .............................................................................................. 26 
        Prerequisites ...................................................................................................... 26 
        Requirements .................................................................................................... 26 
     Crew Chief Trainer ..................................................................................................... 26 
        Prerequisites ...................................................................................................... 26 
        Requirements .................................................................................................... 26 
SOP 10-09 Supervisors ............................................................................................... 27 
  Introduction ........................................................................................................................ 27 
  Qualifications ...................................................................................................................... 27 
  Duties ................................................................................................................................... 27 
  Grievances ........................................................................................................................... 28 
SOP 10-10 Conduct ..................................................................................................... 29 
  Introduction ........................................................................................................................ 29 
  Patient Confidentiality ....................................................................................................... 29 
  Weapons .............................................................................................................................. 29 
  Smoking ............................................................................................................................... 29 
  Alcohol, Controlled Substances, and Medications .......................................................... 29 
SOP 10-11 Sexual Harassment and Nondiscrimination ........................................... 31 
  Sexual Harassment ............................................................................................................. 31 
  Nondiscrimination .............................................................................................................. 31 
  Violations ............................................................................................................................ 31 
SOP 10-12 Infectious Disease Exposure and On Duty Injury .................................. 32 
  Introduction ........................................................................................................................ 32 
  Practices .............................................................................................................................. 32 
  On-Duty Injury or Exposure............................................................................................. 32 
SOP 10-13 Ambulance/Equipment Inspection, Care, and Maintenance ................. 33 
  Introduction ........................................................................................................................ 33 
  Ambulance Maintenance ................................................................................................... 33 
  Equipment Maintenance ................................................................................................... 33 
  Cleaning .............................................................................................................................. 34 
  Accidents/Damage to the Ambulance ............................................................................... 34 
  Failures ................................................................................................................................ 35 
SOP 10-14 Documentation ......................................................................................... 36 
  Introduction ........................................................................................................................ 36 
  General Procedures ............................................................................................................ 36 
  Refusal of Medical Attention (RMA) ............................................................................... 36 
SOP 10-15 Requests for Service and Emergency Dispatch Procedures................ 38 
  Introduction ........................................................................................................................ 38 
  Notification of Calls............................................................................................................ 38 
  EMS Calls ........................................................................................................................... 39 
  Transportation Calls .......................................................................................................... 39 
  Hazardous Material Calls.................................................................................................. 39 
  Stand-by’s and MCI ........................................................................................................... 39 
  Mutual Aid .......................................................................................................................... 39 
  RPI Ambulance unavailability .......................................................................................... 40 
SOP 10-16 Coordinators ............................................................................................. 41 
  Introduction ........................................................................................................................ 41 
  QI Coordinator ................................................................................................................... 41 
  CPR Coordinator ............................................................................................................... 41 
SOP 10-17 Uniforms .................................................................................................... 42 
  Introduction ........................................................................................................................ 42 
  Patches ................................................................................................................................. 42 
  Pins, Collar Brass, Badges ................................................................................................. 42 
  Uniform Classes .................................................................................................................. 42 
     Class A or Dress Uniform .......................................................................................... 42 
     Class B or Casual Uniform ......................................................................................... 43 
     “Class C” Uniform and Other Apparel ....................................................................... 43 
  Fieldstation Crews .............................................................................................................. 43 
SOP 10-18 Radio Communications............................................................................ 44 
  Definitions ........................................................................................................................... 44 
  Radio Identifiers ................................................................................................................. 44 
  RPI Ambulance Vehicle ..................................................................................................... 45 
     Ambulance 5939 ......................................................................................................... 45 
  Radio Codes ........................................................................................................................ 45 
     General Radio Codes .................................................................................................. 46 
     EMS Codes ................................................................................................................. 46 
  Dispatchers.......................................................................................................................... 46 
SOP 10-19 Mutual Aid ................................................................................................. 48 
SOP 10-20 Ambulance Layout/Setup......................................................................... 49 
  Introduction ........................................................................................................................ 49 
  Stretcher .............................................................................................................................. 49 
  Spare Make-up ................................................................................................................... 49 
  IV Fluid clips/retainers ...................................................................................................... 49 
  Portable Oxygen Tanks ..................................................................................................... 49 
  Wall Oxygen Regulators .................................................................................................... 49 
  Onboard Oxygen System ................................................................................................... 50 
  Completed Paperwork ....................................................................................................... 50 
  Other equipment, tools, etc. .............................................................................................. 50 
SOP 10-21 Standby and Event Requests .................................................................. 51 
SOP 10-22 Grievances and Appeals .......................................................................... 52 
  Introduction ........................................................................................................................ 52 
  Grievances ........................................................................................................................... 52 
  Chain of Appeals ................................................................................................................ 52 
  Appeals ................................................................................................................................ 52 
SOP 10-23 Defibrillator ............................................................................................... 53 
  Introduction ........................................................................................................................ 53 
  Care and Maintenance ....................................................................................................... 53 
  Use........................................................................................................................................ 53 
SOP 10-24 Out Of Service ........................................................................................... 54 
  Introduction ........................................................................................................................ 54 
  Day to Day Turnovers ........................................................................................................ 54 
  Extended Periods of Absence ............................................................................................ 54 
SOP 10-25 Patient Transport Destinations ............................................................... 55 
  Introduction ........................................................................................................................ 55 
  Unusual Receiving Facility ................................................................................................ 55 
  Receiving Facility on Diversion......................................................................................... 55 
  Hospital Destination in Mutual Aid Situation ................................................................. 56 
  Transport and Hospital Destination of Major Trauma Patients ................................... 56 
SOP 10-26 Miscellaneous ........................................................................................... 57 
  Introduction ........................................................................................................................ 57 
  Locating Patients ................................................................................................................ 57 
  Special Patients ................................................................................................................... 57 
     Minors......................................................................................................................... 57 
     Emotionally Disturbed Persons .................................................................................. 57 
  Crimes ................................................................................................................................. 58 
  Incident Reporting ............................................................................................................. 58 
  Obvious and Unattended Death ........................................................................................ 58 
  Child Abuse and Maltreatment ........................................................................................ 60 
  Geriatric or Other Patient Abuse/Maltreatment ............................................................ 61 
  Abandoned Infant .............................................................................................................. 61 
SOP 10-27 Approval/Review Document .................................................................... 62 

Appendix A RPI Ambulance BBP
RPI Ambulance Standard Operating Procedures                                  30 November 2010
    SOP 10-00 Organization and Structure

   This document is the Standard Operating Procedures (SOPs) of the Rensselaer
   Polytechnic Institute Ambulance. If one section of the SOPs is amended, suspended,
   deleted, or otherwise changed, the remainder of this document will remain unaffected.

   This document is not to supersede any directives, guidelines, or protocols enacted by a
   higher authority such as the State of New York, the Regional Emergency Medical
   Organization of the Hudson Mohawk Valley Region (REMO-HMVI), or the County of
   Rensselaer. These guidelines are furthermore not to supersede good clinical judgment on
   the part of the crew.

   According to the RPI Ambulance Constitution, the Captain and Medical Director must
   agree upon the SOPs. The Operating Policies must be reviewed on an annual basis by the
   same entities. Documentation of this review will be attached as a separate Policy
   Statement (see SOP 10-27).

   The RPI Ambulance SOPs were originally written in the early 1980’s by George
   Holdsworth, and amended and adjusted by Captains Ken Lavelle, John Kim, and Brian
   Wilde since that time. A major rewrite was initiated by Captain Chris Holt, and
   completed by Captain Fabien Nicaise. The SOPs have since been amended and adjusted
   by Captains Steve Mitchell, Benjamin Saunders, Veronica Voloshinov, and Eric
   Tesoriero. Restructuring of sections and updates reflecting the new officers in the Spring
   of 2010 were made by Peter Ragone. Additional changes during Fall 2010 and Spring
   2011 made by Matthew Willett.




Matthew Willett, Captain                                                                   6 of 62
RPI Ambulance Standard Operating Procedures                                  30 November 2010
    SOP 10-01 Mission Statement
   The mission of this agency is to provide Basic Emergency Medical Services to the
   Rensselaer Polytechnic Institute community, and to transport the sick and injured to
   definitive care. This includes, but is not limited to the following:
       1. Develop standards, policies, and procedures pertaining to Emergency Medical
       Services in order to maintain proper operation of the RPI Ambulance.
       2. Provide Basic Life Support Ambulance Service to the RPI community.
       3. Conduct EMS Quality Improvement to improve the care provided by the RPI
       Ambulance.
       4. Provide training and support services to maintain and improve the Agency’s
       equipment and personnel resources.
       5. Provide training to the Rensselaer community in order to improve the quality of first
       aid in the Rensselaer community and the world at large.
       6. Request and provide reciprocal services, in accordance to the existing provisions of
       the Rensselaer County Ambulance and Rescue Association Mutual Aid Plan, in addition
       to any other Mutual Aid Plans that the Agency becomes involved in.




Matthew Willett, Captain                                                                 7 of 62
RPI Ambulance Standard Operating Procedures                                    30 November 2010
    SOP 10-02 Qualification Procedures - Volunteer Personnel
      Application Procedures
       1. Interested parties should obtain and complete, in its entirety, a membership form as
       supplied by the administration of the agency.
       2. Membership is contingent upon the membership policies outlined in the Agency’s
       constitution.
       3. Every member will resubmit a membership form to the administration of the Agency
       at the beginning of each academic year for the purpose of maintaining an up-to-date
       membership list.

      Orientation
       1. Each new member shall participate in a Membership Orientation as prescribed by the
       Training Committee.
       2. The Membership Orientation shall include the following items:
              a.). RPI Ambulance History, Philosophy, and Structure
              b.) RPI Ambulance Operating Policies and RPI Ambulance Constitution
              c.) Risk Management
              d.) Liability and Confidentiality
              e.) Stress management/CISD
              f.) Health and Safety as outlined below
              g.) PCRs, documentation, and Quality Improvement procedures
              h.) Basic scene support
              i.) Basic call mechanics
              j.) Working with other agencies

      Health and Safety
      1. All members will undergo an annual training in-service on proper procedures on how
      to protect self and crew. This training will comply with and make use of the Agency
      Exposure Control Plan as maintained by the Captain or designated Coordinator.
      2. The Captain and Training Committee will jointly appoint instructors.
      3. This training will include, but is not limited to, the following:
              a.) OSHA Blood borne and Airborne Pathogens
              b.) Infection Control (Per OSHA-29 CFR 1910.1030)
              c.) Personal Protective Equipment
              d.) NIOSH / N95 Healthcare TB Respirator Fit-Testing and usage
              e.) Exposure Control Plan
              f.) TB Testing and Documentation
              g.) Hepatitis-B Vaccination or Refusal and Documentation
              h.) Facilities safety (including Office, PCF, Ambulance)
              i.) Safety during responses
              j.) Basic HAZMAT awareness training
              k.) RPI Ambulance does not require its members to undergo yearly physical
              examinations; however, it asks all members to provide RPI Ambulance with a
              copy of or access to their immunization records to insure the safety of all crews
              and patients.
Matthew Willett, Captain                                                                    8 of 62
RPI Ambulance Standard Operating Procedures                                  30 November 2010
      4. The instructor will generate documentation of yearly Health and Safety training and
      the administration will maintain this documentation in the person’s permanent file.




Matthew Willett, Captain                                                              9 of 62
RPI Ambulance Standard Operating Procedures                                        30 May 2011
    SOP 10-03 Operational Member Types
     Introduction
   In order to act as a volunteer for RPI Ambulance, the appropriate qualifications must be
   met and maintained for the duration of involvement with RPI Ambulance.

     Membership Requirements
  As stated in the Constitution, all members are required to renew membership by attending
  one general meeting or providing written notice to the officer board. If a member fails to
  attend a general meeting or provide written notice to the officer board, they will be
  removed from membership – all training previously completed will be filed, and, upon
  any readmission to the agency, it will be the determination of the Captain and Lieutenants
  as to accepting that member's previous training paperwork or requiring new training.

     Active - I Membership
   Active -I members are the members of emergency crews who participate regularly in
   Agency functions and regularly attend training drills and general meetings. An Active-I
   member meets the following qualifications:
      1. Has submitted a membership form as outlined in SOP 10-02.
      2. Has completed the orientation program outlined in SOP 10-02.
      3. Has completed appropriate annual health and safety training and testing as outlined in
      SOP 10-02 and the agency’s Exposure Control Plan.
      4. Has attended all required training drills or been excused by the Captain or Training
      Committee.
      5. Has attended all required General Membership meetings or been excused by the
      Administration.
      6. Has staffed one night crew or special event in the last month.

     Active - II Membership
   Active - II members are members who are unable to meet all of the qualifications set
   forth in Active - I membership. Former members who visit infrequently and who are
   unable to regularly attend agency drills and meetings should fall into this category. Only
   the Captain may change an Active - II member’s status to Active – I. Conversely, it is
   the responsibility of the Captain to assure that any Active - I members who do not meet
   all of the appropriate qualifications are changed to Active - II membership. An Active -
   II member must meet the following qualifications:
       1. Has submitted a membership form as outlined in SOP 10-02.
       2. Has completed the orientation program outlined in SOP 10-02.
       3. Has completed appropriate annual health and safety training and testing as outlined in
       SOP 10-02.

     Administrative Membership
   An Administrative Member has been accepted by the membership through the guidelines
   set forth in the Agency Constitution, but does not ride actively as part of an EMS crew.
   There are no operational qualifications to be an administrative member. In addition, any

Matthew Willett, Captain                                                                10 of 62
RPI Ambulance Standard Operating Procedures                                       30 May 2011
   member that does not qualify for Active – I and Active – II membership, shall default to
   Administrative Membership until such time that all paperwork and training can be
   brought up to date. Administrative members do not have any Ambulance riding or event
   privileges. An Administrative Member must meet the following qualifications:
       1. Has submitted a membership form as outlined in SOP 10-02.




Matthew Willett, Captain                                                             11 of 62
RPI Ambulance Standard Operating Procedures                                          30 May 2011
    SOP 10-04 Training and Promotions
     Introduction
   One of RPI Ambulance’s primary missions is to further the training of its members.
   Another is to provide competent, professional medical care. This policy seeks to
   guarantee both.

     Training
   Training is to be regarded as a priority second only to patient care, and whenever
   possible, the two should be integrated.

     Training Committee
   The Captain shall establish a training committee, made up of as many members as he sees
   fit. The committee should ideally contain a driver trainer, a crew chief trainer and a
   senior emergency event supervisor. The Captain may or may not serve on the committee.
   The Captain may not be the only member of the Training Committee except with the
   express permission of both lieutenants.

   Once established, removals and additions to the Training Committee must be approved
   by at least 50 percent of the committee as well as the Captain, or by the unanimous
   decision of the Captain and both lieutenants.

   Additionally, once established, the Training Committee must elect a chairperson who will
   be the face and responsible party of the Training Committee; issues that need to be
   brought to the Training Committee or issues arising from the committee should pass
   through this individual.

   The Training Committee shall be responsible for overseeing all training curricula and
   shall also stand as the promotional board, when necessary and applicable. Ideally, the
   committee should meet on a weekly basis, and report back to the Captain fortnightly, or
   as frequently as necessary.

     Back-up Training
   A member who is considered a back up in a position may act in that position provided
   there is a trainer for that position on the crew. The trainer should make every attempt to
   be with the trainee during the course of the call. Notable exceptions may include the
   transport to the hospital, where the trainer and trainee may be separate briefly. A back up
   and a trainer satisfy the requirements for a crew.

     Trainers
   The individuals entrusted with the training of other individuals in the Agency shall
   maintain Active - I membership status. These trainers will be experienced members
   credentialed within the agency for the position they will train. For example, someone
   who is experienced enough to be a Driver Trainer may not necessarily be a Crew Chief
   Trainer. Trainers are appointed by the Training Committee. Consideration of appointees

Matthew Willett, Captain                                                                  12 of 62
RPI Ambulance Standard Operating Procedures                                            30 May 2011
   will not only consist of individuals’ qualifications within a specific area of credentialing,
   but also of their ability to teach and train effectively.

For specific qualifications and promotion requirements, please see the appropriate sections:
       Crew Chief                            SOP 10-08, pg. 23
       Driver                                SOP 10-07, pg. 18
       Attendant                             SOP 10-06, pg. 17
       Emergency Event Supervisor            See Special Event SOPs
       Duty Supervisor                       SOP 10-09, pg. 27

These requirements and qualifications are considered to be the minimum requirements for
promotion. It is often expected that members will do additional training and will be promoted
when the Training Committee and Captain are satisfied that they hold the necessary skills
required for the promotion. If there are concerns about the performance of a promotion candidate
the Training Committee is to work with the individual to address the concerns.

      Promotional Boards: Structure
   The Promotional Board is a vehicle used by members of RPI Ambulance to progress
   through the ranks of the organization’s credentialing structure. The promotional board
   shall consist of:
       1. Training Committee
       2. Captain
   The Promotional Board shall be chaired by the Training Committee Chairperson, except in
   the case of that individuals promotion, when the Captain shall act as the Promotional Board
   Chair.

   If the Captain or a member of the Training Committee is the candidate for promotion,
   their spot will be back-filled from the hierarchical list. When composing the Promotional
   Board, the Training Committee will make an effort to use the highest priority names, but
   will not make unreasonable concessions in scheduling or timing of the Promotional
   Board in order to do so.

   It is understandable that not every member of the promotional board will have been
   involved with all aspects of a candidates training. Therefore, any member is invited to
   speak for or against the candidate at the Promotional Board as this is a time for the
   promotional board to learn about a candidate’s skills and competencies. Members may
   speak about any aspect of the candidate but it is the chair’s duty to ensure that comments
   remain relevant. I.e. personal attacks should not be tolerated. During the voting section,
   only the actual members of the promotional board may be present.

   While the candidate is present, the Promotional Board should take the opportunity to ask
   relevant questions of the candidate about his or her competency in the position applied
   for. Outlandish questions and inappropriate attitudes are not acceptable.




Matthew Willett, Captain                                                                 13 of 62
RPI Ambulance Standard Operating Procedures                                             30 May 2011
     Promotional Boards: Voting
   After the chair has presented the candidate for promotion, and when there are no more
   questions for the candidate, the candidate will be asked to leave the room. The candidate
   will comply.

   The chair is the parliamentarian for the voting proceedings. Any and all discussion
   behind closed doors is understood to be confidential and will not be discussed with
   anyone. After discussion is complete to the satisfaction of the chair, the members of the
   Promotional Board will vote on the candidate.

   Voting will not take place by secret ballot. At least two-thirds members of the
   Promotional Board must give a “yes” vote of confidence for the candidate to pass and be
   credentialed in the position applied for. No abstentions are acceptable. Members with a
   potential conflict of interest should not be on the promotional board, and an alternate
   should be present as outlined above. Thus, a conflict of interest is not a valid excuse for
   an abstention.

   If the candidate passes the promotional vote, they will be called back into the room by the
   members of the Promotional Board and advised by the Chairperson.

   If the candidate does not pass the promotional vote, they will be called back into the
   room by the members of the Promotional Board and advised of such by the Chairperson.
   Any member who voted “no” should be prepared to outline what additional
   demonstration of competence they would like to see before they would register a “yes”
   vote. This should be done both in writing and verbally. The candidate shall have the
   right to ask for a clarification of requests. This is to give the candidate a fair opportunity
   to improve in weak areas and become a more viable candidate for the next promotional
   board that they petition.




Matthew Willett, Captain                                                                     14 of 62
RPI Ambulance Standard Operating Procedures                                            30 May 2011
    SOP 10-05 Observer

     Functional Job Description
       Observer
       The Observer position is for members of any membership status or non-members who
       are interested in riding on an Ambulance Crew for observational and/or informational
       purposes. Non-members desiring to engage in a ride-a-long can be considered
       observers under this functional description. The observer need not have any
       qualifications, but must adhere to the following guidelines:
           1. Be briefed in RPI Ambulance SOPs, Patient Confidentiality, Risk Management,
           and Infection Control/OSHA.
           2. The Observer will not engage in providing patient care of any kind.
           3. At the discretion of the Crew Chief, the Observer may be asked to sit in the cab
           compartment while patient care is being extended.
           4. If the number of people on board the Ambulance becomes too large (with ALS
           providers, multiple patients, family/friend of the patient, etc., the Observer may be
           left at the scene by the Crew Chief. If this happens, every effort will be made to
           assure that someone can bring the Observer to the destination to meet up with the
           Ambulance.
           5. The Observer will sign a form effective for a specified amount of time (to be
           indicated on the form) agreeing to all of the above. In addition, the form shall
           indemnify and hold harmless RPI Ambulance, Rensselaer Polytechnic Institute, and
           all of its members and subsidiaries from any liability in the event of injury, illness, or
           death.

       Orientation Member
       The Orientation Member shall be an Active - I or Active - II member who desires to
       ride on an Ambulance Crew for the purpose of gaining experience, training, or
       otherwise familiarizing oneself with the operations of RPI Ambulance. The
       Orientation Member:
           1. Shall assist in patient care as requested by the Crew Chief and will act only under
           the direction of the Crew Chief.
           2. May be asked to sit in the cab compartment by the Crew Chief while patient care
           is being extended.
           3. If the number of people on board the Ambulance becomes too large (with ALS
           providers, multiple patients, family/friend of the patient, etc., the Orientation Member
           may be left at the scene by the Crew Chief. If this happens, every effort will be made
           to assure that someone can bring the Orientation Member to the destination to meet
           up with the Ambulance.




Matthew Willett, Captain                                                                     15 of 62
RPI Ambulance Standard Operating Procedures                                       30 May 2011
     Training
       Ambulance Orientation Member
       As this is an entry-level position, there is no formal requirement and no training needed
       except for that which is required to become a member of RPI Ambulance as stated in
       SOPs 10-02 and 10-03. This is meant to be an temporary position. The goal of all
       orientation members is to become an Ambulance Attendant. It is expected that
       Orientation members begin Attendant training before their third night crew.

        Prerequisites
          None

        Requirements
         1. Must maintain Active - I or Active - II membership in RPI Ambulance.




Matthew Willett, Captain                                                               16 of 62
RPI Ambulance Standard Operating Procedures                                          30 May 2011
    SOP 10-06 Ambulance Attendant

     Functional Job Description
   The Ambulance Attendant shall be an Active - I or Active - II member who rides on an
   Ambulance Crew for the purpose of assisting the Crew Chief with patient care as well as for
   the purpose of gaining further experience and training in EMS The Ambulance Attendant
   shall:
       1. Hold current certification in American Heart Association Healthcare Provider CPR or
       equivalent.
       2. Be familiar with the location, use, and function of all medical equipment on board the
       Ambulance
       3. Possess a working knowledge of RPI Ambulance Operation Policies.
       4. Be familiar with safe techniques for lifting and moving of patients using common
       equipment.
       5. Pass a training course (to include the above) as prescribed by the Training Committee.
       6. Be approved by the Training Committee and Captain for promotion

     Training
   The Ambulance Attendant trainee will begin their formal training with a class provided by
   RPI Ambulance that will cover the basics and requirements. The Ambulance Attendant
   should also practice their skills and knowledge when they are on a crew, with the help and
   guidance of the Crew Chief in order to increase the knowledge of the trainee and to build
   Crew Chief’s confidence in the trainee. The trainee is also encouraged to attend as many
   training drills as possible as they are a good source of knowledge and additional training.

       Prerequisites
       None
       Promotion
       1. Be CPR for Professional Rescuer certified.
       2. Attend an RPI Ambulance Attendant training class to include:
          a.) Call Dynamics
          b.) Standard Operating Procedures
          c.) In house first aid (not required for CFRs or higher)
          d.) Equipment orientation
       3. Complete the attendant checklist.
       4. Complete the ambulance equipment checklist.
       5. Actively participate in at least one (1) call, or show evidence of outside experience.




Matthew Willett, Captain                                                                   17 of 62
RPI Ambulance Standard Operating Procedures                                          30 May 2011
    SOP 10-07 Emergency Vehicle Operator Roles and
    Responsibilities
     Function Job Description
   The E.V.O., also known as the Driver, is the person responsible for transporting the patient
   and crew as necessary on an EMS or transportation call. The Driver’s responsibilities are
   outlined in SOP 10-07. The Emergency Vehicle Operator will meet the following
   qualifications:
    Must maintain Active - I membership in RPI Ambulance.
    Must possess a NYS Class D License or equivalent.
    Must be credentialed as an Ambulance Attendant for RPI Ambulance and maintain
       appropriate CPR certification.
    Must complete the following FEMA sponsored classes IS-700 National Incident
       Management System (NIMS), ICS 100: Introduction to ICS, and ICS 200: Basic ICS.
    Must be trained in safe operation of the ambulance as outlined in SOP 10-07
and 10-06
    Must pass a promotional board as set forth by SOP 10-04 and SOP 10-07.

       Introduction
       The driver of the ambulance holds a critical position in the care and treatment of the
       patient. It is the driver’s responsibility and obligation to deliver the crew and ambulance
       to the scene in a safe manner, to facilitate transport of the patient into the ambulance, to
       transport the patient and crew while maintaining a suitable working platform for effective
       patient care, and to return the crew to quarters or to another suitable drop off point in a
       safe and professional manner. The ambulance is a moving advertisement for RPI
       Ambulance, Rensselaer Polytechnic Institute, and the entire RPI community. The manner
       in which the ambulance is driven and the impression it conveys are the primary contact
       the majority of the public has with our agency.

       Definitions
       Priority 2 - Ambulance operation using no emergency lights or sirens, following all V&T
       laws. Synonyms: Routine, Code 2, Cold.

       Priority 1 - Ambulance operation using emergency lights and siren. Synonyms:
       Emergency, Code 3, Hot.

       NB: The driver has responsibility and liability for safe operation and must maintain
       compliance with RPI Ambulance driving procedures. The driver is personally liable for
       any injury or damage sustained during Priority 1 operation.

       Driver Qualifications
       Any individual who drives the ambulance must be properly credentialed as an RPI
       Ambulance Emergency Vehicle Operator (a.k.a. driver) or must be a valid driver trainee
       with a driver trainer present, as described in SOP 10-07.

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RPI Ambulance Standard Operating Procedures                                           30 May 2011
       General Driving Procedures
       During all travel of the ambulance, including, but not limited to, travel to dinner or a
       class meeting, Priority 2 operation or Priority 1 operations, the driver will adhere to the
       following rules:
       1. A spotter must be used at all times whenever backing the ambulance.
       2. Anyone sitting in any compartment of the ambulance must wear a seat belt anytime
           the vehicle is in motion or in traffic. During patient care, providers in the rear
           compartment may remove their seatbelts if required.
       3. Any non-member passengers should ride in the front compartment of the ambulance
           and wear their seat belt at all times the vehicle is in motion. In cases of pediatric
           patients or other special cases where the passenger calms or soothes the patient, the
           passenger may ride with the patient but must still wear their seat belt
       4. Headlights are to be used at any time the ambulance is in motion.
       5. Respond to all emergency calls Priority 1 except when downgraded by the Crew
           Chief. (See SOP 10-15)
       6. When dispatched to a standby, always respond in Priority 2 mode.
       7. Return from the hospital or RPI Student Health Center in Priority 2 mode.
       8. Transport from the scene to the hospital or RPI Student Health Center at the response
           level designated by the Crew Chief.
       9. Leave the ambulance engine running at all times during a call until arrival at the
           hospital or RPI Student Health Center.
       10. Upon arrival at the hospital or RPI Student Health Center, shut down the engine prior
           to unloading the patient.

       Emergency Driving Procedures
       During Emergency procedures, the driver will adhere to the following rules in addition to
       the above and to NYS Vehicle & Traffic laws:
       1. A complete stop is mandatory before proceeding with caution at all red lights, stop
           signs, and railroad crossings, regardless of response level.
       2. If using the median, turning lane, or a lane of opposing traffic to enter an intersection,
           come to a complete stop before proceeding with caution.
       3. Come to a complete stop at all times for any school bus either in the same lane or in
           the opposing lane with flashing red lights displayed.
       4. Do not exceed posted speed limit by more than ten (10) miles per hour at any time.
       5. Do not exceed posted speed limit at any time when passing through an intersection
           with the green light.
       6. When traveling in a lane of traffic in an opposing direction, do not exceed 20 mph.
       7. Leave warning lights (no less than secondary lights) on if the ambulance is stopped
           on or at the edge of a roadway, or if the ambulance will interfere with traffic, or at
           any time that the warning lights will increase scene safety for EMS personnel.

       Driver’s Duties
   1. Duties During a Scheduled Duty Crew:
      a) Complete an RPI Ambulance Vehicle/Mechanical Checklist once per shift.
      b) Notify the Duty Supervisor of any problems or discrepancies.


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RPI Ambulance Standard Operating Procedures                                            30 May 2011
      c) If possible, and if the Crew Chief consents, familiarize self and crew with areas of our
         Primary Territory and response areas.
      d) Drive crew where they need to go in a safe manner
   2. Duties During a Call:
      a) Be sure that the ambulance is clear of personnel and other obstructions or dangers,
         and that all exterior doors are closed before getting into the driver’s seat.
      b) Verify that all ambulance personnel are in secure positions before moving the
         ambulance.
      c) Upon starting the ambulance verify that all gauges and operation indicators are within
         nominal ranges, especially fuel level and oil pressure.
      d) Drive to the scene in a safe and efficient manner at an appropriate level of response.
      e) Park at the scene in a position to provide optimal access to the patient while
         maintaining scene safety.
      f) Leave the vehicle running at all times while on scene.
      g) Assist the Crew Chief in providing care on scene as needed.
      h) Upon arrival at the hospital or RPI Student Health Center, turn off the ambulance and
         assist the crew in unloading the patient from the patient compartment.
      i) Assist the crew in transferring the patient to the hospital bed.
   3. While at the hospital, the following driver’s duties are to be done in the following order,
      highest priority first:
      a) After the patient is unloaded, return to the ambulance and shut off any nonessential
         items. (especially A/C, heat)
      b) Clean and disinfect the ambulance as appropriate per the RPI Ambulance Exposure
         Control Plan.
      c) Get the stretcher ready for service
      d) Make sure the ambulance is still within Part 800 equipment parameters.
      e) Contact Rensselaer County Dispatcher by phone to obtain run times and number as
         needed by the crew chief
      f) Assist the Crew Chief if requested.

       Spotters
       To reiterate previously stated policy, whenever the ambulance is in reverse, all drivers
       must use a spotter in order to maintain a safe service and a professional looking
       ambulance.

       To properly spot the vehicle when it is backing up, the spotter should stand
       approximately 10 feet behind the ambulance on the driver’s side. The driver should be
       able to see the spotter at all times and must stop if the spotter moves to a position where
       they cannot be seen. Conversely, the spotter should be able to see the driver’s mirror at
       all times as well.

       The spotter should look out for obstacles and indicate that it is safe to continue in reverse
       with a left-handed “come here” motion, palm facing the spotter. To indicate that it is
       unsafe to continue or that there is an obstacle in the path of the vehicle, the spotter should
       make a fist with his or her left hand with the palm side facing the driver.


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RPI Ambulance Standard Operating Procedures                                         30 May 2011
      There are situations where using an external spotter is impossible. These situations are:
      1. When backing into the hospital ER (Emergency Room)
      2. During the reverse phase of the cone course.

       In these two circumstances only, is it permissible for a vehicle occupant in the patient
       compartment (i.e. the Crew Chief on a call, or the observing trainee in the cone course) to
       go to the tailgate end of the crew bench and look out the back windows the entire time the
       vehicle is in reverse to be on the lookout for any obstacles, pedestrians, or other items
       that would present a hazard to the ambulance.

       Back-Up Alarm
       Use common sense when using the back-up alarm. When backing without an external
       spotter, it must be used. However, if an external spotter is used, and a loud alarm is not
       advisable (e.g. backing up near residences late at night, backing up at the garage after
       dark, etc., the Back-up alarm may be temporarily deactivated. Unless scene safety
       considerations prohibit its use, the Back-Up alarm should be used on all emergency
       scenes.

       Travel Limits
       It is the driver’s duty to ensure a speedy response to any incident on campus. As such,
       the driver will be responsible for assuring the Ambulance is never too far from campus to
       respond in a safe and efficient manner. As a minimum, the following boundaries should
       never be crossed, except on a properly dispatched mutual aid call:
            North:     An east-west line even with TFD. Station 1 (115th St)
            East:      A north-south line even with McDonald’s restaurant on Hoosick St.
            South:     An east-west line even with TFD. Station 6 (Canal Ave)
            West:      The Hudson River

       It is also recommended that unless there is a specific reason for travel to the above limits,
       such as food or training, the ambulance should remain as much as possible in the area
       immediately around the campus. However, this is left to the discretion of the driver so
       long as he or she can ensure a safe and efficient response.

     Training
       Back-up Driver
       The Driver trainee will begin their formal training with a class provided by RPI
       Ambulance that will cover the basics of what is required.
        Prerequisites
          1. Trainee must be an RPI Ambulance Attendant.
        Requirements
          1. Must possess a NYS Class D License or equivalent.
          2. Attend an RPI Ambulance E.M.V.O training class to include:
             a) Call Dynamics
             b) Standard Operating Procedures
             c) Applicable Laws
             d) Basic Practical Orientation
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RPI Ambulance Standard Operating Procedures                                 30 May 2011
         3. Complete Driver Check Sheet and Vehicle Maintenance Sheet
         4. Complete 10 hours of driver training as a third person with a qualified driver
            trainer and submit driver evaluation sheet to the Training Committee or the
            Captain which will be kept on file.
         5. Request to become a Back-up Driver
         6. Receive joint approval of the Captain and Training Committee

       Driver
        Prerequisites
          1. Must be a Back-up Driver
        Requirements
          1. Complete and Pass one (or more) of the following emergency vehicle operator
             courses, with documentation kept on file by the Training Committee:
             a) Coaching the Emergency Vehicle Operator (CEVO) Ambulance
             b) Emergency Vehicle Operator Course (EVOC)
          2. Must complete the following FEMA sponsored classes:
             a) IS-700 National Incident Management System (NIMS)
             b) ICS 100: Introduction to ICS
             c) ICS 200: Basic ICS
          3. Pass Driver Practical Exam
          4. Request to become a Full Driver
          5. Receive approval by the Promotional Board

       Driver Trainer
        Prerequisites
          1. Must be an RPI Ambulance Driver
        Requirements
          1. Be a Driver for 4 months while the ambulance is in service
          2. Drive 3 emergency or non-emergency calls
          3. Assist in teaching a driver class
          4. Request to become a trainer
          5. Receive joint approval of the Training Committee and the Captain




Matthew Willett, Captain                                                           22 of 62
RPI Ambulance Standard Operating Procedures                                        30 May 2011
    SOP 10-08 Crew Chief
     Function Job Description
   The Crew Chief is the supervisor of the Ambulance Crew in Medical Protocol and Agency
   Procedure. The Crew Chief’s responsibilities are outlined in SOP 10-08. The Ambulance
   Crew Chief will meet the following qualifications:
      1. Must maintain Active - I membership as an RPI Ambulance member.
      2. Must maintain current certification by the New York State Department of Health,
         Bureau of Emergency Medical Services, as an Emergency Medical Technician or
         higher. Certification from any other state alone is not acceptable.
      3. Must maintain current AHA Healthcare Provider CPR or equivalent.
      4. Must meet all criteria for Ambulance Attendant as listed above.
      5. Must complete the following FEMA sponsored classes IS-700 National Incident
         Management System (NIMS), ICS 100: Introduction to ICS, and ICS 200: Basic ICS.
      6. Must pass the Ambulance Crew Chief course as set forth by the Training Committee
         and Captain.
      7. Must pass a promotional board as set forth by SOP 10-04 and SOP 10-08.

       Introduction
       The Crew Chief is the leader of the Ambulance Crew. The State Department of Health
       mandates that there must be at least one current NYS EMT providing patient care in the
       patient compartment of the ambulance in accordance to NYS BLS protocols. The RPI
       Ambulance Crew Chief has been trained not only in Basic Life Support treatment of
       emergency patients, but also in how to appropriately handle situations that may arise
       during any phase of operations. This includes, but is not limited to: dealing with
       problematic patients, decision-making, MCI’s, and interacting with other agencies. The
       Crew Chief is directly responsible for the conduct and appearance of the Ambulance
       Crew. All members of the Ambulance Crew should feel comfortable communicating with
       the Crew Chief any questions they may have. The Crew Chief may not necessarily be the
       highest medical authority on scene, but at RPI Ambulance, the Crew Chief is
       procedurally in charge.

       Qualifications
       Any individual who acts in the capacity of Crew Chief must be properly credentialed as
       an RPI Ambulance Crew Chief or must be a valid Crew Chief Trainee with a Crew Chief
       Trainer present. As such, any person acting as the Crew Chief must meet the
       qualifications as set forth in SOP 10-08.

       General Procedures
      1. If the Crew Chief does not feel comfortable with a situation, a member, or is
         uncertain how to handle a predicament, they should contact the Duty Supervisor.
      2. If a disagreement between RPI Ambulance and an ALS provider exists, the Crew
         Chief will put aside any personal or agency differences and make decisions based in
         the best interest of the patient.
      3. If a disagreement between RPI Ambulance and another EMS agency, dispatch center,
         Public Safety Authority, or other official exists, the Crew Chief will not act on behalf
         of the agency in solving the problem but rather will act in the best interest of the
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RPI Ambulance Standard Operating Procedures                                   30 May 2011
         patient. The Crew Chief will also immediately notify the Duty Supervisor, who will
         evaluate the situation and decide how best to handle it.
      4. Maintain communications with any/all appropriate dispatch center(s) throughout
         operations, either alone or by designating another crewmember. The Crew Chief is
         responsible for all of these radio communications, though another member may use
         the radio with the express consent of the Crew Chief.
      5. Maintain control of the Ambulance Cellular Phone. No member may use the phone
         without the permission of the Crew Chief.

       Crew Chief’s Duties
       1. Duties during a scheduled Duty Crew:
          a) Make sure that an Ambulance Equipment Checklist is completed by the Crew.
          b) Report any discrepancies or problems to the Duty Supervisor.
          c) Make sure that any vacancies on the crew are filled to assure that all members
             who want to ride crews are able to do so in a timely manner.
          d) If possible, provide training opportunities for the rest of the Crew.
          e) Maintain Crew morale and try to accommodate the wishes of the Crew.
          f) If a Crew member needs to study while on a duty crew, this will take precedence
             over driving around and other endeavors. We are students first.
       2. Duties During a Call:
          a) Confirm that there is a crew, and if in 24-Hour Service (i.e. no Duty Crew
             scheduled), try to include trainees on the call.
          b) Advise the Emergency Vehicle Operator of the appropriate level of response to
             the scene if different from the standard.
          c) During travel to the scene, plan ahead for any equipment or additional resources
             (e.g. fire apparatus, Hazmat Unit, additional Ambulances) that may be needed.
          d) Upon arrival, notify appropriate dispatcher(s).
          e) Try to maintain set of response times on a separate sheet.
          f) Prior to egress from the vehicle to the scene, the Crew Chief will assess the scene
             for safety and advise the Ambulance Crew of how to appropriately protect
             themselves from any hazards that may be present. The Crew Chief is responsible
             for the safety of the crew at all times.
          g) The Crew Chief will be in charge of all patient care and will act as the interface
             between the RPI Ambulance Crew and a provider of a higher level of care.
          h) The Crew Chief will attempt to allow other members to train in positions they are
             attempting to gain RPI Ambulance credentialing in (e.g. Crew Chief, Attendant)
             within their level of credentialing (i.e. if the Crew Chief is also a Crew Chief
             Trainer).
          i) Provide BLS care at the level that RPI Ambulance is certified to provide.
          j) Select the appropriate patient carrying device and use it to bring the patient to the
             ambulance.
          k) Transport to a Hospital Emergency Department within a reasonable area. The
             patient has final choice, but the crew chief should make every attempt to convince
             the patient to go to a local hospital. Take into consideration the geographic ability
             to get back in service for the next call. The appropriate hospital Emergency
             Departments are:

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RPI Ambulance Standard Operating Procedures                                         30 May 2011
            i. Samaritan Hospital ER
            ii. Saint Mary’s Hospital ER
            iii. Ellis Hospital ER
            iv. St. Clare’s Hospital ER
            v. Albany Medical Center Hospital ER
            vi. Saint Peter’s Hospital ER
            vii. Albany Memorial Hospital ER
            viii. Stratton VA Medical Center ER
         l) If the hospital requests a diversion, attempt to comply as best as possible:
            i. Explain to the patient the nature of the change and ask if they have another
                 preference.
            ii. Select next closest hospital if possible.
            iii. If patient is critical and next hospital is too far, consider continuing to the
                 same hospital
            iv. Patient transportation during a diversion must follow SOP 10-25
         m) While en route to the medical facility, provide medical care as appropriate.
         n) Use the Ambulance VHF Radio to contact the Emergency Department with the
            following information:
            i. Age and gender
            ii. Chief complaint
            iii. History of chief complaint
            iv. Pertinent past medical history and medications
            v. Pertinent vital signs
            vi. Treatment rendered by this agency and others (i.e. Oxygen by RPI, Signal 600
                 by TFD)
            vii. Estimated time to arrival
         o) Upon arrival at the medical facility, shut down any nonessential ambulance items.
            (E.g. dome lights, heat or A/C, vent, etc.
         p) Give a report to the appropriate staff member.
         q) If at a hospital ER, assist the registration clerk in obtaining patient information
            and try to get a face sheet.
         r) Complete paperwork, obtain times and numbers, and notify appropriate dispatch
            center(s) that we are available for the next call, using the telephone at the medical
            facility.
         s) Verify that the Driver has prepared the ambulance for the next call.
         t) Leave the medical facility in a reasonable amount of time and return to service as
            appropriate.

     Training
   The position of Ambulance Crew Chief is the highest credentialed position in the Ambulance
   Crew. Becoming an Ambulance Crew Chief involves not only medical proficiency, but also
   thorough knowledge of all Operating Policies and an ability to lead the crew effectively. The
   Crew Chief Trainee should, while training, act in the capacity of Crew Chief to the best of
   his or her ability. The training period is a time to gain experience with a trained Crew Chief
   on board. The Crew Chief Trainee is encouraged to attend as many drills as possible as they
   are a good source of knowledge and training.

Matthew Willett, Captain                                                                25 of 62
RPI Ambulance Standard Operating Procedures                                     30 May 2011

       Back-up Crew Chief
        Prerequisites
          1. Trainee must be an RPI Ambulance Attendant.
          2. Host current certification as a NYS EMT-Basic or higher
          3. Maintain active CPR for Healthcare Provider certification
        Requirements
          1. Attend an RPI Ambulance Crew Chief training class to include:
             a) Call Dynamics
             b) Standard Operating Procedures
             c) PCR writing
             d) Crew Chief 1 simulated call
          2. Complete Crew Chief checklist
          3. Complete 1 mock call in the presence of a CC Trainer before Crew Chief a real
             call.
          4. Crew Chief 2 calls with a crew chief trainer in the patient compartment
          5. Pass the practical exam, including PCR writing
          6. Receive joint approval of the Captain and Training Committee

       Ambulance Crew Chief
        Prerequisites
          1. Must be a Back-up Crew Chief
        Requirements
          1. Must Crew Chief 1 call as a Back-up Crew Chief, receive a passing evaluation
             and be recommended for promotion by a Crew Chief Trainer
          2. Must complete the following FEMA sponsored classes:
             a) IS-700 National Incident Management System (NIMS)
             b) ICS 100: Introduction to ICS
             c) ICS 200: Basic ICS
          3. Must student-teach one training drill and submit an evaluation form
             a) This training drill must be approved and supervised by the training committee
          4. Request to be a full Crew Chief
          5. Receive approval by the Promotional Board

       Crew Chief Trainer
        Prerequisites
          1. Must be an RPI Ambulance Crew Chief
        Requirements
          1. Be a Crew Chief for 4 months while the ambulance is in service
          2. Crew Chief 3 emergency or non-emergency calls
          3. Assist in teaching a Crew Chief class
          4. Request to become a trainer
          5. Receive joint approval of the Training committee and Captain




Matthew Willett, Captain                                                            26 of 62
RPI Ambulance Standard Operating Procedures                                           30 May 2011
    SOP 10-09 Supervisors
     Introduction
   In the EMS field, many problems exist, from operations to interpersonal conflict. The
   position of Supervisor is created to provide easy access to an experienced member who can
   act in the capacity of Crew Chief or Driver if the need arises. The Supervisor also acts as a
   screen to the Captain so that matters that can be resolved by the Supervisor don’t need to
   unduly tie up the Captain. The position of Supervisor is not a Credentialed Promotion, and as
   such, it does not fall under the auspices of Training Committee.

     Qualifications
   The Supervisor Shall:
      1. Be currently credentialed as a Crew Chief Trainer, Driver Trainer, and Fieldstation
         Event Supervisor by RPI Ambulance
      2. Maintain at least 70% compliance in agency QI as a Crew Chief.
      3. Have completed an interview with the Captain testing the knowledge of RPI
         Ambulance operations, Standard Operating Policies, Mutual Aid, and the geography
         of Rensselaer County and Surrounding Areas.
      4. Be appointed by the Captain with input from other Line Officers and other
         Supervisors after the successful completion of the aforementioned interview.

     Duties
   All Supervisors:
       1. Will act as the scheduled Duty Supervisor for at least 24 hours per week.
       2. Must remain within radio range of both RPI Public Safety, Rensselaer County
          Dispatcher, and the Ambulance, and will be able to establish communication to the
          Ambulance Crew via the Ambulance Cellular Phone during their on duty time.
       3. Should notify the appropriate officer in the proper time, if the Supervisor notices
          anything that requires attention from that officer. For example, the Captain and
          Ambulance Lieutenant need to know right away that the Ambulance has a flat tire,
          whereas the Training Committee could probably be notified in the morning if one of
          the CPR manikins is broken.
       4. Will act in an appropriate manner at all times while acting on behalf of RPI
          Ambulance.
       5. Will not take over care of a patient, driving responsibilities, or any other duties of the
          crew unless patient or crew safety is in jeopardy.
       6. Will file incident reports as necessary to maintain proper documentation of incidents.
       7. The On-Duty supervisor is expected to assist the responding ambulance in the
          following situations
          1. MCI- Any incident that involves more than 2 patients or in which there are
              patients in excess of the available resource.
          2. Any rescue incident that would involve a crew being on scene an anticipated time
              exceeding 20 minutes.
          3. Any incident where crowd control may cause an issue to the responding units.
              This includes but is not limited to fraternity houses and large events.

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RPI Ambulance Standard Operating Procedures                               30 May 2011
         4. Any incident where ALS is requested, where an ALS unit is not available for
            immediate response.

     Grievances
   Any grievance with a Supervisor or the actions of a Supervisor will be forwarded as soon as
   possible to the Captain, who will investigate the matter fully. If an individual does not feel
   comfortable approaching the Captain, another Supervisor may be notified of the grievance or
   the member may contact the Grievance Committee of RPI Ambulance. Care should be taken
   to avoid a rumor mill when dealing with such grievances as matters can quickly be blown out
   of proportion. Always try to use the proper communications channels.

   If the Captain feels that the grievance has merit, the Captain will attempt to mediate any
   dispute between the involved parties. If one or both parties are unsatisfied with this approach,
   the matter will follow SOP 10-22 for grievances and appeals.




Matthew Willett, Captain                                                                  28 of 62
RPI Ambulance Standard Operating Procedures                                         30 May 2011
    SOP 10-10 Conduct
     Introduction
   Our conduct and appearance are a very important part of patient care and the image that we
   extend to the RPI Community, as well as to the community at large. Poor professional
   conduct has a negative impact on patient care and erodes the relationships we have with the
   community and health care teams. While this policy statement deals with some specific
   issues relating to Pre-hospital Emergency Care, conduct should always be governed by
   treating all people in a manner that one would want to be treated in any given circumstance
   and reflects positively on the entire organization.

     Patient Confidentiality
   All information regarding patient contact is confidential in nature, and not a matter of public
   record. All requests for information regarding patient contacts or member information must
   be referred to the Captain. All information is protected in accordance with the Health
   Insurance Privacy and Portability Act (HIPPA). While medical personnel will frequently
   discuss cases as a learning or Quality Improvement tool, it must be realized that this
   information must not be discussed outside the Agency. In no case, including learning or
   Quality Improvement, should the patients name or personal information be used.

     Weapons
   Under no circumstances is any member of RPI Ambulance allowed or authorized to carry a
   weapon. EMS Personnel are allowed to carry a small-sized folding knife to facilitate rescue
   and not be used as a weapon. If a scene is not secure or safe, the crew should not enter and
   should wait for a Public Safety Agency to render the scene safe. The Crew Chief should
   make appropriate notifications if a Public Safety Agency has not already been dispatched to
   the scene.

     Smoking
   The Surgeon General of the United States has recognized smoking as a health hazard.
   Accordingly, it is a danger to the health of patients and co-workers. In addition, RPI
   Ambulance carries oxygen, which will accelerate burning and it is therefore a hazard to have
   any open flame in or near the ambulance. Therefore, smoking is not permitted in any RPI
   Ambulance vehicle or any of its associated facilities.

   Additionally, as of 1 July 2010, Rensselaer has become a tobacco-free institution, thereby
   banning use of an tobacco products anywhere on the campus.

     Alcohol, Controlled Substances, and Medications
   Alcoholic beverages or other controlled substances are not allowed under any circumstances
   within the RPI Ambulance building, the Primary Care Facility, any Fieldstation post, or any
   RPI Ambulance vehicle.

   Consumption of alcohol by any member is prohibited while in any uniform part, agency
   apparel and/or eight (8) hours prior to being on duty. Agency apparel includes RPI
Matthew Willett, Captain                                                                 29 of 62
RPI Ambulance Standard Operating Procedures                                   30 May 2011
   Ambulance off-duty wear, uniform, any item of clothing with the words “RPI Ambulance”,
   an RPI Ambulance patch or logo on it, or the like.

   Under no circumstances is a member allowed to attend a call while their abilities are
   impaired or their judgment diminished by any cause, including but not limited to: alcohol,
   drugs, medication, or lack of sleep.

   No person shall be permitted to ride in any agency vehicle while under the influence of
   alcohol or intoxicating substances unless they are the patient.

   Any member who acts in an official capacity while perceived to be under the influence of a
   drug, including alcohol, will be relieved of their duties by the Crew Chief or Supervisor and
   suspended from Active - I and Active - II membership until the incident is reviewed by the
   Captain and Executive Committee.

   Any member who is found in possession of alcoholic beverages or other controlled
   substances on RPI Ambulance property, including but not limited to RPI Ambulance
   vehicles, buildings and offices or who is found to store or provide any alcoholic beverages or
   other controlled substances to others on RPI Ambulance property will be relieved of their
   duties by the Crew Chief or Supervisor and suspended from Active – I and Active – II
   membership until the incident is reviewed by the President, the Captain and the Executive
   Committee. The committee may temporarily or permanently relieve the member from his or
   her Crew Chief, Driver and/or Officer duties. In case an officer is temporarily relieved of
   his/her duties, the President will appoint a temporary administrative officer or the Captain
   will appoint a temporary line officer until the original officer is allowed to resume his duties
   in accordance with the Executive Committee decision. If an officer is permanently relieved
   of his/her duties, the President will appoint a temporary administrative officer or the Captain
   will appoint a temporary line officer until the next General Meeting at which time a new
   officer may be elected by the general membership. If the President or the Captain is
   temporarily or permanently relieved of his/her duties, the Vice-President or Ambulance
   Lieutenant, respectively, will take over the open position until the original officer is allowed
   to resume his/her responsibilities or until the election of the new officer by the membership
   at the next general meeting.




Matthew Willett, Captain                                                                  30 of 62
RPI Ambulance Standard Operating Procedures                                       30 May 2011
    SOP 10-11 Sexual Harassment and Nondiscrimination
     Sexual Harassment
   RPI Ambulance strives to achieve excellence through its members. As such, RPI Ambulance
   prohibits sexual harassment of any type and adheres strictly to the Sexual Harassment Policy
   as listed in the Rensselaer Handbook of Student Rights and Responsibilities.

     Nondiscrimination
   RPI Ambulance adheres to the nondiscrimination policy of Rensselaer Polytechnic Institute.
   RPI Ambulance admits qualified individuals to its membership without regard to gender,
   sexual orientation, marital status, age, race, color, religion, national or ethnic origin, or
   disability.

     Violations
   Any discrepancies in adherence to this policy should be brought to the Captain, who will
   inform the appropriate parties within the Rensselaer Polytechnic Institute community.




Matthew Willett, Captain                                                               31 of 62
RPI Ambulance Standard Operating Procedures                                       30 May 2011
    SOP 10-12 Infectious Disease Exposure and On Duty
    Injury
     Introduction
   In order to minimize the risk of infectious disease exposure, all members must employ
   universal precautions and proper PPE/BSI in compliance with the agency’s Exposure Control
   Plan. Refer to the Exposure Control Plan for specific details.

     Practices
   In accordance with OSHA regulations, RPI Ambulance created and maintains an Exposure
   Control Plan designed to minimize the occurrence of on-duty exposure. The policies set
   forth in the plan should be adhered to whenever patient care is being extended. The major
   requirements are summarized here for clarity:
       1. Always wear gloves when extending patient care.
       2. When the gloves are soiled, replace them.
       3. Always wash hands after providing care.

     On-Duty Injury or Exposure
   In the event of an On-Duty Injury or Exposure:
       1. Immediately notify the Duty Supervisor, who will notify the Captain.
       2. Obtain appropriate medical care, and with the assistance of the Duty Supervisor or
           Captain, fill out a “Report of Medical Treatment” form.
       3. Any and all on duty injuries and exposures should be evaluated at a medical facility.
           If the RPI Student Health Center is closed, do not hesitate to seek medical treatment
           at an ER as soon as possible.
       4. Appropriate records of any treatment shall be obtained and maintained by the Captain
           in a confidential manner.
       5. With the Agency’s Medical Director, the Captain will investigate the injury/exposure
           to determine the following:
           a) If RPI Ambulance policy was followed, and if failure to follow policy was the
               cause of injury/exposure
           b) If appropriate infection control precautions/personal protective equipment were
               used while providing patient care
           c) Assuming appropriate PPE/BSI was used, if PPE/BSI was used inappropriately or
               if PPE/BSI failed
           d) Methods to prevent such an exposure or injury in the future.
       6. Copies of these reports will be kept in the member’s confidential personnel file.




Matthew Willett, Captain                                                               32 of 62
RPI Ambulance Standard Operating Procedures                                        30 May 2011
    SOP 10-13 Ambulance/Equipment Inspection, Care, and
    Maintenance
     Introduction
   In order to respond effectively to emergencies, all vehicles and equipment must be in top
   operational condition.

     Ambulance Maintenance
   The ambulance will checked on every crew.

   In addition, the First Lieutenant will ensure that the ambulance is service in accordance with
   Ford’s recommended service plan and that any problems that develop are quickly remedied

   Every effort to see that the ambulance vehicle complies with all state motor vehicle laws and
   Part 800 regulations regarding ambulance equipment.

   The vehicle will have an annual DMV inspection.

   The Captain or his/her designee is responsible for maintaining records including, but not
   limited to the following:
        When and where the vehicle was purchased/obtained
        Documentation pertaining to repairs
        Maintenance schedule according to vehicle manufacturer’s instructions
        Documentation pertaining to all maintenance performed on the vehicle

   Documentation of vehicle maintenance shall include inspection records as well as records of
   services performed either by the RPI Ambulance members, outside vendors, and
   representatives of the vehicle manufacturer. This documentation will include any service
   bulletins or recall notices issued by the manufacturer and records of compliance with their
   recommendations. These records shall be kept by the Captain or his/her designee and shall be
   made available to the Department of Health upon inspection, as requested.

     Equipment Maintenance
   All equipment will be checked on every crew.            Any deficiencies will be reported
   immediately to First Lieutenant.

   All equipment will be maintained according to the manufacturer’s recommendations
   including, but not necessarily limited to the following:
        Performing manufacturer’s recommended calibrations/inspections
        Performing manufacturer’s recommended service (including lubrications)
        Replacing and servicing batteries, as applicable
        Proper inspection of all equipment available to the provider
        Proper cleaning and disinfecting procedures


Matthew Willett, Captain                                                                33 of 62
RPI Ambulance Standard Operating Procedures                             30 May 2011
   The following equipment will be examined and checked by a third party maintenance
   company:
       Stretchers and stretcher mounting hardware
       AED
       Pulse Oximeter
       Suction Devices
       Rechargeable Battery Powered Lights
       Manual BP Cuffs
       Patient stabilization/Transportation/Immobilization Devices
       Oxygen Regulators and Delivery Systems

     Cleaning
   The Ambulance vehicle will be cleaned and equipment/supplies replaced after each
   ambulance call. The Emergency Vehicle Operator is responsible for cleaning the driver
   compartment of the vehicle and the patient care personnel are responsible for the patient care
   compartment. Cleaning will be done according to the Bloodborne and Airborne Pathogens
   Exposure Control Plan. When soiled, all re-usable equipment will be cleaned in accordance
   to the RPI Ambulance Exposure Control Plan. All disposable equipment will be discarded
   when soiled, even if not used.

   Any safety or maintenance problems with the vehicle will be immediately brought to the
   attention of the Maintenance Committee Chairperson or the Captain.

     Accidents/Damage to the Ambulance
   In the event of any accident involving RPI Ambulance, even if there is no damage or injury
   to any involved party:
       1. Immediately assess the crew and other involved party or parties for any injuries, and
           notify the appropriate dispatch center(s).
       2. If transporting a patient, discontinue transport. Transfer care and transport of the
           patient to another transport agency. Leaving the scene of an MVA for any reason is
           considered a hit and run. At the discretion of the Crew Chief, if the accident occurs
           while transporting a critical patient and the ambulance can still be driven safely, a
           crewmember may be left behind at the scene while the ambulance continues to the
           hospital.
       3. Notify the Duty Supervisor, Ambulance Lieutenant and Captain immediately. Notify
           RPI Public Safety and have DPS and the appropriate police agency take a report. File
           a report with DPS and the Police, regardless of the amount of damage incurred.
       4. The Emergency Vehicle Operator and/or Trainee driving the vehicle at the time of the
           accident will be suspended as a driver but may still participate at other levels (such as
           Crew Chief or Attendant, as applicable). Coverage should be found by the Duty
           Supervisor to finish the shift, or if no cover can be found, the Duty Supervisor will
           cover the shift.
       5. Each member of the Duty Crew will file an incident report with the Captain with
           regard to how the accident occurred.


Matthew Willett, Captain                                                                   34 of 62
RPI Ambulance Standard Operating Procedures                                           30 May 2011
     Failures
   Any vehicle or equipment failures must be immediately referred to the Captain and First
   Lieutenant in writing. The captain will then notify the manufacturer(s), the State, and any
   other applicable entities of the failure as needed. If the failure resulted in harm to a patient,
   the details of the injury(s) must also be detailed and a copy of the PCR should be included in
   the report to the Captain.




Matthew Willett, Captain                                                                   35 of 62
RPI Ambulance Standard Operating Procedures                                          30 May 2011
    SOP 10-14 Documentation
      Introduction
   Good documentation is essential to relay information to other healthcare providers, to obtain
   management information, and for medical-legal purposes. RPI Ambulance must comply with
   all New York State Department of Health and Regional Emergency Medical Organization
   documentation programs and will follow all procedures.

      General Procedures
   1. There will be only one (1) Pre-hospital Care Report (PCR) filled out for each patient.
       The exception is for public events, where an on site PCR and a transport PCR will be
       completed.
   2. Responsibility for accurate and complete documentation lies with the person listed in the
       “In Charge” box on the PCR. As such, only Crew Chiefs and Crew Chief Trainees who
       hold an EMT card may write PCRs for RPI Ambulance.
   3. The Pink Copy provided by any First Response agency (e.g. TFD.) will be stapled to the
       PCR and left at the hospital along with the RPI Ambulance PCR.
   4. When completing paperwork, the PCR will go on top, followed by any continuation
       form(s), followed by any First Response PCR, followed by any hospital face sheet,
       followed by the RPI Ambulance Trip Report.
   5. All documentation will be completed in black ink using a ballpoint pen. This ensures
       clarity in reading both the original and any copies made.
   6. All documentation will be legible. Anyone who picks up the PCR needs to be able to read
       it.
   7. Only abbreviations on the “REMO Approved Abbreviations List” will be used on PCRs.
   8. All documentation will be clear and concise and is up to the judgment of the Crew
       Chief/Crew Chief Trainee how best to document any given incident.
   9. The PCR will be retained for seven years for patients over the age of eighteen. The PCR
       will be retained for seven years after the patient’s eighteenth birthday for patients under
       the age of eighteen.
   10. All information contained in the PCR shall be held in the utmost confidentiality, and held
       in a fireproof safe in accordance with state and local protocols.

      Refusal of Medical Attention (RMA)
   While patients of sound mind and judgment have the right to refuse medical care, a patient’s
   capability to make a rational decision often becomes an issue at a later date. For this reason,
   it is imperative that all assessment findings and any advice given to the patient is documented
   in the narrative section of the PCR before they sign the release.
        1. Complete the PCR first.
        2. Complete the RMA form.
        3. The assessment and your advice indicating they seek medical attention should be read
           aloud to the patient. The patient should be allowed to read the narrative and the
           disclaimer on the back of the PCR as well as the RMA form.
        4. Have the patient sign the RMA on the back of the PCR and the RMA form. Have a
           reliable witness sign both as well, preferably a Law Enforcement Officer or a family
           member. A member of the crew cannot witness a refusal.
Matthew Willett, Captain                                                                   36 of 62
RPI Ambulance Standard Operating Procedures                                           30 May 2011
      5. Patients under 18 years of age are considered minors under New York State law and
         are not allowed to refuse medical attention unless legally emancipated.
      6. Intoxicated patients under the age of 21 are not allowed to refuse medical attention.
         Generally, law enforcement will be on the scene of any incident of this type. If the
         patient wishes to refuse medical attention, the help of an officer should be obtained to
         persuade the patient that transport to a hospital ER is in their best interest.
      7. Similarly, if the patient is in need of care and wishes to refuse, try to convince the
         patient to accept care and seek help of law enforcement if necessary. If the patient
         still refuses to go, document well and allow them to leave.
      8. If there is any question whether the patient should RMA or there is a situation of
         unusual nature in which the patient does not want to be transported to the hospital,
         contact a Medical Control Physician and discuss the situation with them and follow
         their guidance. On your PCR document, the Physician’s three-digit MD number and
         what they advised you to do.




Matthew Willett, Captain                                                                37 of 62
RPI Ambulance Standard Operating Procedures                                       30 May 2011
    SOP 10-15 Requests for Service and Emergency Dispatch
    Procedures
     Introduction
   Rensselaer County Bureau of Public Safety is the official dispatcher for RPI Ambulance. All
   medical emergency calls originating on campus are transferred to Rensselaer County
   Emergency Medical Dispatcher who assigns the priority determinant for the call and
   dispatches RPI Ambulance. All non-emergency medical calls originating on campus are
   transferred to Rensselaer County in the same fashion as the emergency calls from the
   Rensselaer County Dispatcher or from the RPI Student Health Center.

   Rensselaer County Emergency Medical Dispatcher will also dispatch RPI Ambulance for any
   mutual aid calls originating in the county.

   Rensselaer County can be reached via the following numbers:

       Emergency Number: 911
       Non-Emergency Numbers: 270-5252 / 270-1037

     Notification of Calls
   The county dispatcher will notify the members of RPI Ambulance of the call, including
   nature and location, via the high band portables with the accompanying paging tones
   broadcasted over high band frequency, 155.220, heard on channel 1 (one) or 2 (two) of the
   RPI Ambulance high band portable radios.

   All communications between crew members at any point before, during or after the call and
   communications with Rensselaer County Emergency Medical Dispatcher prior to calling en
   route from the ambulance shall be done over channel 1 (one), 155.220, of the RPI
   Ambulance high band portable radios.

   Upon recognition of the tones, when a duty crew is available, a Crew Chief, carrying a high
   band portable, shall acknowledge the call and confirm the crew with the county dispatcher.
   In the case when the duty crew consists of less than 4 people, the Crew Chief, at his/her
   discretion may ask for one or two additional members to meet him/her at the ambulance.

   If the call comes in during the day when no duty crew is available, any available Crew Chief
   and a Driver shall notify the other members of their response and acknowledge the call with
   Rensselaer County. If only a Crew Chief or a Drive is available, he/she may ask the
   Rensselaer County Dispatcher to re-dispatch for a Crew Chief or a Driver, as necessary.
   Once the crew is confirmed, the responding Crew Chief shall confirm the crew with the
   county dispatcher. Any other members wishing to respond will make a request to the Crew
   Chief and upon Crew Chief’s permission meet the crew at the ambulance. Once at the
   ambulance, the Driver shall call en route via the 800 MHz mobile radio system mounted in
   the ambulance. All further communications with the Rensselaer County Dispatchers and/or
   other responding agencies shall be done over the 800 MHz mobile radio system or over the
   800 MHz portable radio.
Matthew Willett, Captain                                                                38 of 62
RPI Ambulance Standard Operating Procedures                                           30 May 2011

   If for some reason the Crew Chief or the Driver is unable to acknowledge the call or confirm
   the crew with the Rensselaer County over the high band portables on RPI Ambulance
   frequency 155.220, he/she may confirm a crew with the dispatcher via personal telephone if
   they can do so without undue delay by dialing 270-1037. If the crew is unable to establish
   communications with the Rensselaer County over the 800 MHz radio system, they may
   contact the county over the cellular phone located in the RPI Ambulance by dialing 270-
   1037.

     EMS Calls
   Calls received from the county dispatcher will include a determinant.

   Alpha determinant calls will be treated as Priority 2 calls as defined in SOP 10-07.

   Bravo, Charlie, Delta, Echo determinant calls will be treated as Priority 1 calls as defined in
   SOP 10-07.

     Transportation Calls
   RPI Ambulance routinely transports patients to and from the RPI Student Health Center who
   are unable to ambulate. This is a service which should not be abused. An individual who is
   on crutches or able to ambulate with assistance does not need the services of an ambulance.
   If no other means of transport is available, RPI Ambulance will attempt to get a crew to
   transport the patient.

     Hazardous Material Calls
   RPI Ambulance is not equipped or trained to handle Hazardous Material (Haz-Mat)
   situations. As such, no member may enter Haz-Mat scene until trained professionals have
   properly decontaminated it. The Crew Chief is responsible for ensuring the safety of the
   crew and should keep the crew back far enough to be away from the hazardous agent.

     Stand-by’s and MCI
   RPI Ambulance is a participant in Mutual Aid with other agencies who may call upon us as a
   resource in the event of multiple patient incidents (MCI), long standbys, etc. Response to
   these scenes will always be in Priority 2 mode. Lights and sirens will not be used to respond
   to these incidents unless there is a patient waiting for our services, in which case the incident
   is no longer a standby response, but begins a new PCR as an EMS call.

   If the dispatch entity requests RPI Ambulance to respond to an incident Priority 1, then RPI
   Ambulance will do so if the Crew Chief feels comfortable with that judgment.


     Mutual Aid
   RPI Ambulance provides and receives Mutual Aid through signed agreements held with both
   the Rensselaer County Ambulance and Rescue Association and the Troy Fire Department.
   When Rensselaer County Bureau of Public Safety receives a request for RPI Ambulance

Matthew Willett, Captain                                                                   39 of 62
RPI Ambulance Standard Operating Procedures                                      30 May 2011
   from an agency covered under these agreements, the call will be dispatched as a Mutual Aid
   call to the requesting agency, and crew/vehicle acknowledgements will proceed normally.

   Any mutual aid call will be handled according to SOP 10-19.

   Other agencies within (and outside of) the county may request RPI Ambulance through the
   Rensselaer County Mutual Aid Plan. Other agencies/dispatch centers include, but are not
   limited to:
        Rensselaer County 911/Emergency Communications Center (Town of Brunswick,
           North Greenbush, etc.)
        Mohawk Ambulance Service
        Empire Ambulance Service
        The Watervliet Fire Department
        The Green Island Fire Department
        The Town of Colonie (Colonie EMS)
        The Cohoes Fire Department
        The Albany Fire Department
        The Regional Emergency Medical Alert Center (Re/MAC)

     RPI Ambulance unavailability
   If RPI Ambulance is unavailable for a call the next available ambulance according to the
   mutual aid plan shall be called. This will happen in accordance with SOP 10-24 and the
   current dispatch plan with Rensselaer County Bureau of Public Safety.




Matthew Willett, Captain                                                             40 of 62
RPI Ambulance Standard Operating Procedures                                           30 May 2011
    SOP 10-16 Coordinators
     Introduction
   To assist in the completion of their jobs, the line officers of RPI Ambulance are empowered
   to appoint coordinators. This gives the coordinator selected powers that the appropriate
   officer may have while still referring all responsibility for the job to the appropriate officer.
   Some specific positions follow.

     QI Coordinator
   The Quality Improvement Coordinator coordinates the completion of QI audits and tabulates
   the data and reports to the Captain. The QI Coordinator and/or the Captain represent RPI
   Ambulance at meetings of the Rensselaer County QI Committee. If desired, the Captain may
   elect to act as the QI coordinator.

   The QI coordinator is responsible for ensuring compliance with the Rensselaer County QI
   program and thereby the Region and State program. The Captain and QI coordinator should
   periodically review the Rensselaer County QI program to evaluate its effectiveness to RPI
   Ambulance and to ensure it meets all State and Regional requirements.

     CPR Coordinator
   The CPR Coordinator is in charge of coordinating CPR events sponsored by RPI Ambulance
   and reports to the Training Committee. The CPR Coordinator need not be a CPR Instructor
   but instead assures that instructors are available to hold scheduled CPR training. The CPR
   Coordinator should work closely with the Training Committee and the Vice-President. If
   desired, the Training Committee may elect to act as the CPR coordinator.




Matthew Willett, Captain                                                                   41 of 62
RPI Ambulance Standard Operating Procedures                                         30 May 2011
    SOP 10-17 Uniforms
     Introduction
   In an effort to gain respect and convey a professional manner to the community, RPI
   Ambulance has established different categories of uniform standards. This will provide
   continuity and an easy way to communicate the appropriate uniform to members of a Duty
   Crew.

     Patches
   RPI Ambulance patches will only be worn on a white uniform shirt or blue RPI Ambulance
   jacket. The RPI Ambulance agency patch will be worn on the left shoulder. NYS DOH
   certification patches of the “Excelsior” design with tombstone shape and navy blue
   background will be worn on the right shoulder. If a member does not hold NYS DOH
   certification, a 2 inches x 3 inches American flag patch with gold border may be worn on the
   right shoulder. No other patches may be worn on any part of the uniform.

     Pins, Collar Brass, Badges
   Any pin to be worn on the RPI Ambulance uniform must be approved by the Captain.
   Exceptions are day-to-day wearing of the blue jacket while not on a Duty Crew, though
   discretion should be used in this matter as well. The Captain has the right to ask a pin to be
   removed from an RPI Ambulance jacket.

   Officers should wear their collar brass on the collars of their jackets and their white uniform
   shirts. Non-officer members are not required to wear collar brass, but may opt to wear silver
   caduceus, or a combination of silver “RPI”, “RPI Ambulance”, “RPIA”, ”EMS”, or “EMT”
   lettered brass as appropriate.

   Badges should not be worn during duty crews. For special events, badges may be worn with
   the authorization of the Captain. In some cases, the different role we serve by being an EMS
   agency and not a Public Safety agency can play in important role in patient rapport. It is for
   this reason that we must keep a clear distinction between RPI Ambulance and other Public
   Safety agencies.

     Uniform Classes
       Class A or Dress Uniform
       This is the Dress Uniform used by RPI Ambulance. It consists of:
           White collared RPI Ambulance uniform shirt with T-Shirt worn underneath
           Black slacks or EMS Pants
           Black belt with silver or black buckle
           No dangling earrings or jewelry
           Black, shined, closed-toe shoes or boots. No high heels.
           Black socks (if socks visible)
           RPI Ambulance approved navy blue jacket (Seasonal)



Matthew Willett, Captain                                                                 42 of 62
RPI Ambulance Standard Operating Procedures                                       30 May 2011
       Class B or Casual Uniform
       This is the standard uniform used by RPI Ambulance. It consists of:
           Red RPI Ambulance polo shirt with emblazoned RPI Ambulance logo and
               lettering over left chest.
           No patches or collar brass
           Black slacks or EMS Pants
           Black belt with silver or black buckle
           No dangling earrings or jewelry
           Black, closed-toe shoes or boots. No high heels.
           Black socks (if socks visible)
           RPI Ambulance approved navy blue jacket (Seasonal)

       “Class C” Uniform and Other Apparel
       When not assigned to duty crews, RPI Ambulance members may wear RPI Ambulance
       apparel such as t-shirts or sweatshirts with the RPI Ambulance name and logo on them.
       This apparel does not constitute any official uniform; as such, duty crews must be in
       either Class A or Class B uniforms. However, it is understood that individuals willing to
       respond to day calls may want to appear professional, but without having to wear a full
       Class A or B uniform. In this case, use of this so-called “Class C” uniform is strongly
       encouraged.

       Ideally, it should look as close to the Class B Uniform as possible, but it is understood
       that people don’t always wear their uniforms around campus all day. It consists of:

             A neat un-torn shirt, preferably dark, if possible RPI Ambulance- or EMS-
              oriented. No fluorescent or obscene T-shirts are allowed. Extra RPI Ambulance
              shirts are available on the ambulance.
             Neat, un-torn pair of pants, preferably dark. Jeans are fine but shorts are not
              permitted. Long pants are available on the Ambulance.
             Solid footwear. No open-toed shoes or sandals. No high heels.
             RPI Ambulance approved navy blue jacket

     Fieldstation Crews
   In fieldstation crews for events such as athletic events, hockey games, concerts, etc.,
   Fieldstation Crew Chiefs, Fieldstation Attendants, and Fieldstation Orientation Members
   may wear Class B uniforms. Fieldstation Event Supervisors at athletic events, hockey
   games, concerts, etc. must wear either the Class A or Class B uniform.

   All members at Institute and Special Functions (e.g. Special Events/Presentations,
   Commencement, etc.) will wear the Class A Uniform. The Captain has the ability to
   designate any event as a Special Function. If an event is designated as a Special
   Function, it should be made such at least one (1) week ahead of time to allow members to
   plan accordingly.



Matthew Willett, Captain                                                               43 of 62
RPI Ambulance Standard Operating Procedures                                    30 November 2010
    SOP 10-18 Radio Communications
     Definitions
       F.C.C. - The Federal Communications Commission. The Federal agency charged with
      regulating the use of radio communications to facilitate fair use by all.
      Call sign - The alphanumeric reference sequence given to all operators of radio
      communications equipment by the FCC. RPI Ambulance’s call sign is WNFR-574.
      Mobile Radio - A radio, usually with transmitting power of about 35-40 watts, mounted
      in a vehicle, which uses the vehicle as a power source.
      Portable Radio - A radio with power ranging from 1 to 5 watts, which is able to be
      carried by a person and has its own power source built-in.
      Encoder pad - The touch-tone pad on a radio, which enables it to send the necessary tones
      to hospital Emergency Departments to relay information about incoming patients. See
      D.T.M.F.
      D.T.M.F. - Dual Tone Multi-Frequency. A system developed by AT&T/Bell Labs in the
      1960’s to allow numeric signals to be sent over common means of audio communication.
      Key up - To activate the Push-to-talk switch on a radio.
      Squelch - The ability of a radio to filter out extraneous noise and other transmissions.
      The threshold between silence and static can be breached by opening the squelch. There
      are four types used by RPI Ambulance:
              C.S.Q. - Carrier Squelch. Squelch with no other special functions. Any
              transmissions made, as well as some extraneous noise, may be heard by the
              listener.
              P.L. - Private Line system. Generically, C.T.C.S.S. (Continuous Tone Coded
              Squelch System). Channels with a P.L. tone in place will only allow the squelch
              to open if a sub-audible tone (ranging from approximately 30 to 190 Hz) is
              transmitted simultaneously with any radio transmission. Helps to filter out
              extraneous noise and unwanted transmissions (e.g. by people who share our
              frequency).
              D.P.L. - Digital Private Line. Developed by Motorola, a more sophisticated
              version of P.L.
              Quik-Call II - A Motorola function that allows a channel to be set to Alert Mode,
              wherein the squelch will only open if a sequential two-tone transmission is given,
              usually by a dispatcher.
      Repeater - A system that hears radio transmissions on one frequency and then
      simultaneously re-transmits them on another. Dramatically increases the range of a radio
      system.

     Radio Identifiers
   Any individual using the radio system should use the appropriate identifier. If none of the
   following identifiers apply, or a 900-series identifier has not yet been issued and they need to
   transmit on the RPI Ambulance frequency, they should describe themselves as “Member (last
   name)”. For example, John Doe would identify himself as “Member Doe”. At no time should
   an individual’s 900 series number be used on any frequency outside of the Rensselaer
   Polytechnic Institute Community.

Mathew Willett, Captain                                                                   44 of 62
RPI Ambulance Standard Operating Procedures                               30 November 2010
   RPI Ambulance Personal Identifiers - range sequentially from 920 through 989 and are
   assigned to members by the Captain upon joining the agency. Once a member has an ID
   number, that number is assigned to the member until such time as he or she has not been a
   member of RPI Ambulance for more than 1 year.

   Fieldstation Crews - Should use numbers as outlined in the Fieldstation Policy (see Special
   Event SOPs. These numbers range from 900 sequentially through 909 and should be used for
   no other purpose.

   Any Department of Public Safety Officer will use their assigned 200, 300, 500, or 700-series
   number to identify themselves. If any DPS officer is also a member of RPI Ambulance, they
   will be issued an RPI Ambulance number unique to them. They will use the number for the
   agency that they are representing at that time.

     RPI Ambulance Vehicle
   RPI Ambulance vehicles should use the following identifiers. This is the only identifier to be
   used when in interagency communications (e.g. Rensselaer County, etc).

       Ambulance 5939
       The Driver and Crew of Ambulance 39. Individual crew members should refer to each
       other as their personal ID numbers. If a crew member is unfamiliar with the personal ID’s
       of another crew member, they may refer to them simply as their functional job
       description within the ambulance crew such as “Ambulance 39 Driver”.

     Radio Codes
   Within our system, we may use radio codes to communicate a message. The purpose of this
   is twofold:
       1. Everyone at RPI Ambulance uses the same codes, so the message is clear and
           understood
       2. Radio codes lessen the amount of time transmitted. This conserves battery power as
           well as creating less traffic on the frequency so someone else is able to transmit.
   There is never requirement for any member to use a code. If a member is not certain which
   radio code to use or is unfamiliar with the codes, plain English should be used. It is better to
   take a little more time to get a message through than to be misunderstood, or not understood
   at all.

   At no time should the use of codes hinder communications.
   These radio codes are to be used only when communicating on the RPI Ambulance and DPS
   frequencies. Use of these codes on any other frequency will create confusion and mixed
   messages. Plain English should be used when dealing with any agency other than RPI
   Ambulance or DPS

   At RPI Ambulance, the following are accepted radio codes/language. The 10 may be omitted
   at times by custom or practice.

   These are the same codes used by DPS, as they are the agency we most frequently work with.
Mathew Willett, Captain                                                                   45 of 62
RPI Ambulance Standard Operating Procedures                                   30 November 2010

       General Radio Codes

• 10-4 O.K.                                     • 10-65 Clear for Assignment
• 10-7 Unit out of service                      • 10-66 Call cancelled
• 10-8 Unit in service                          • 10-71 Albany Medical Center
• 10-9 Repeat                                   • 10-81 Samaritan Hospital
• 10-19 Return to Base or location as stated    • 10-82 St. Mary’s Hospital
• 10-20 Location                                • 10-85 Unlock door
• 10-30 Ambulance                               • 10-86 Gallagher Health Center
• 10-31 Lights & Sirens                         • 10-97 Arriving on scene
• 10-33 Food, lunch, break, bathroom            • 10-98 Finished at scene
   These codes for reference only and are not expected to be memorized.

       EMS Codes
       Calls can be classified by their nature. In some cases, discretion may be needed in
       communicating with DPS, the County Dispatcher, or the receiving hospital. In those
       cases, EMS codes are to be used. If the receiving entity does not understand, the codes
       revert back to using plain English. In the case that the dispatcher uses a code you are not
       familiar with, ask them to use plain English. It may also be advisable to communicate by
       cell phone if the situation needs discretion.
    • Code 0: Cardiac Arrest                         • Code 5: Psychiatric
    • Code 1: Respiratory Arrest                     • Code 5R: Restrained Psychiatric
    • Code 2: Dead on Arrival                        • Code 6: Discretion needed/Relatives
    • Code 3: Drug Overdose                          • Code 7: Police Needed
    • Code 4: Symptoms of Intoxication

     Dispatchers
   If we are on RPI Ambulance’s frequency, call the Department of Public Safety. Refer to the
   dispatcher as either “Headquarters”, or simply “Public Safety”.

   In the Rensselaer County Emergency Communications System, refer to the dispatcher as
   either “Dispatcher”.

   If we need to transmit on Mohawk’s frequency without being requested, say “RPI
   Ambulance 39 to Mohawk Dispatch...”

   If we need to transmit on Empire’s frequency without being requested, say “RPI Ambulance
   39 to Empire Dispatch...”




Mathew Willett, Captain                                                                  46 of 62
RPI Ambulance Standard Operating Procedures   30 November 2010




Matthew Willett                                   Page 47 of 62
RPI Ambulance Standard Operating Procedures                                 30 November 2010
    SOP 10-19 Mutual Aid
   Under the Rensselaer County Mutual Aid Plan, RPI Ambulance and other Rensselaer County
   agencies have the ability to request Mutual Aid from each other under the following
   constraints:

   Rensselaer County will maintain RPI Ambulance run number and response times in
   accordance with existing Rensselaer County Dispatch policies.

   After being dispatched for a Mutual Aid call, RPI Ambulance will call the requesting
   dispatcher and request any information needed such as call location, directions, and patient
   status.

   Upon arrival at the hospital, RPI Ambulance should call arriving the appropriate dispatcher’s
   frequency notify the dispatcher that they are returning to RPI’s frequency, and return to RPI
   Ambulance’s primary frequency. Then, notify the Rensselaer County Dispatcher that RPI
   Ambulance is clear of the Mutual Aid call and back in normal dispatch procedures.




Matthew Willett, Captain                                                               48 of 62
RPI Ambulance Standard Operating Procedures                                     30 November 2010
    SOP 10-20 Ambulance Layout/Setup
     Introduction
   In order to maintain regularity and continuity between different crews, there is a certain
   approved method for storing certain pieces of equipment on the ambulance. There is also a
   certain method to setting up some pieces of equipment to facilitate patient care.

     Stretcher
   The stretcher’s location is self-evident; it goes in the stretcher mounts on the floor of the
   ambulance. The attendants should not place their feet on the stretcher during general driving
   around, as it may jeopardize the sanitary nature of the stretcher.

   Always make certain that the stretcher is properly latched in place and will not come loose
   during transit. This is especially important if there is a patient on the stretcher. The stretcher
   must be in lowest position in the ambulance for it to be properly secured. The adjustable leg
   and head ends of the stretcher should be adjusted as necessary for patient care during a call
   but should be left flat during general driving. If desired the head end of the stretcher may be
   raised one notch to provide some leg space for the attendants riding in the back.

     Spare Make-up
   The make-up on the stretcher is supplemented by a spare make-up to be stored in the vertical
   shelves next to the curbside access doors. The spare make-up is to be used in cases where a
   quick turnaround is needed. If the spare make-up is used, the crew should replace it as soon
   as possible. In cases of expected large volume, more spare make-ups may be kept on the
   ambulance at the discretion of the Captain and/or the crew chief.

     IV Fluid clips/retainers
   The devices provided for holding and securing IV fluid bags are for just that. Do not store
   other equipment there as it can fall down at very inopportune moments.

     Portable Oxygen Tanks
   In addition to the portable tank stored in the Mega-duffel, two tanks will be stored in the
   double-tank holder at the head-end of the crew bench. There should be two full tanks secured
   here with a regulator on at least one at all times, except when they are in use. If one is empty
   it should be replaced a soon as possible. If no other room is available and tanks must be
   secured, they should be nestled snugly in the bottom of the crew bench with the valve end
   protected by extra linen, towels, etc.

     Wall Oxygen Regulators
   Both wall Oxygen regulators should remain on the action wall area in the two ports on the
   driver’s side of the Ambulance. If a patient using oxygen is lying on the crew bench side, the
   regulator may be moved during that transport to facilitate easy movement for the crew
   throughout the patient compartment.



Matthew Willett, Captain                                                                    49 of 62
RPI Ambulance Standard Operating Procedures                                 30 November 2010
     Onboard Oxygen System
   Whenever the onboard system is used, the system should not remain charged for any longer
   then absolutely necessary so as to avoid damaging the system and losing oxygen through
   leaks, loose fittings, etc.

     Completed Paperwork
   After a call, any paperwork completed for the call should be stapled together as described in
   SOP 10-14 and immediately placed into the “PCR Lockbox” inside of the RPI Ambulance
   Office whenever possible; non-duty crew calls may result in paperwork being placed in the
   “PCR Lockbox” located in the garage. Under no circumstances are completed PCRs to be
   left in the ambulance.

     Other equipment, tools, etc.
   Not all equipment for the ambulance is listed here. Maintain the remainder of the ambulance
   equipment and supplies in their proper locations as directed by the Ambulance Lieutenant.
   Checklists should be done at the start of every duty crew in accordance with SOP 10-13.




Matthew Willett, Captain                                                               50 of 62
RPI Ambulance Standard Operating Procedures                                   30 November 2010
    SOP 10-21 Standby and Event Requests
All policies and procedures for handling events outside of duty crews and day calls as previously
described in these SOPs can be found in the RPI Ambulance Special Event Standard Operating
Procedures.




Matthew Willett, Captain                                                                 51 of 62
RPI Ambulance Standard Operating Procedures                                     30 November 2010
    SOP 10-22 Grievances and Appeals
        Introduction
   Members of an organization often have disagreements, either business or personal. Fair
   treatment of everyone is the best policy to avoid problems of this type. This is not always
   possible and therefore it is important to have in place a formal system to bring complaints
   forward so they may be resolved in a fair and efficient manner.

        Grievances
   Disagreements can best be solved by taking the problem directly to the person(s) in question.
   This brings the issue into the open so that all parties involved may work to an adequate
   solution.
   Sometimes this does not lead to an equitable solution or simply is not possible because one
   person is intimidated or another person comes on too strong. In such cases, the issue should
   be brought to the appropriate officer (Captain or President) based on the nature of the
   complaint. As an alternative, the member may contact the Grievance Committee of RPI
   Ambulance.
   The Grievance Committee exists to handle complaints among members. All grievance
   brought to the committee are strictly confidential. See the Grievance Committee
   Constitution for details.

        Chain of Appeals
   1.    President, Captain, or Grievance Committee
   2.    Executive Committee of RPI Ambulance
   3.    General Membership of RPI Ambulance
   4.    Advisory Committee of RPI Ambulance
   5.    Union Executive Board or Judicial Board

        Appeals
   In any situation where one or more of the parties are unhappy with decision following a
   grievance or previous appeal, that party shall have the right to appeal to the next higher
   authority. That group shall handle the appeal in a confidential and professional manner at its
   next possible opportunity.

   Any member of an appeals body with a conflict of interest shall excuse themselves from the
   proceedings. For instance, if the there is a complaint against the Secretary, when the appeal
   goes before the officer board, the secretary shall not sit to hear the appeal. If the complaint is
   against the entire Executive Committee of RPI Ambulance, that level of appeal shall be
   skipped.




Matthew Willett, Captain                                                                    52 of 62
RPI Ambulance Standard Operating Procedures                                  30 November 2010
    SOP 10-23 Defibrillator
     Introduction
   As part of its continuing mission to provide quality patient care, RPI Ambulance carries an
   Automated External Defibrillator. In order to ensure its continued functioning, it is
   important that the unit be properly used and cared for.

     Care and Maintenance
   The unit will be tested at the start of each shift. Any deficiencies should be reported to the
   Ambulance Lieutenant immediately.

     Use
   1. The unit will be used in an emergency situations only. For training, the training module
      should be used.
   2. In accordance with NYS – DOH protocols, the unit will only be applied on an
      unconscious person who presents without a pulse. The AED should not be used to
      monitor a conscious patient.
   3. The Crew Chief shall be responsible for and in charge of the AED throughout its use.
   4. If, at any time, a paramedic assumes care of the patient, they will be in charge of patient
      care, but the Crew Chief is still responsible for use of the AED.
   5. The Captain or his designee shall be notified of use as soon as is feasible so that the
      patient record can be properly downloaded and recorded.
   6. The Captain and crew will meet with the agency Physician as soon as feasible to review
      the crew actions and evaluate the use of the AED.




Matthew Willett, Captain                                                                53 of 62
RPI Ambulance Standard Operating Procedures                                     30 November 2010
    SOP 10-24 Out Of Service
     Introduction
   By the nature of RPI Ambulance being college based it is recognized that there are periods
   when members cannot commit to responding to a call. These may be times when all crew
   chiefs are in class, a period before a test, etc. In addition, during summer vacations when
   students are away, the members may also be away and the service may be unable to respond.
   This policy seeks to address the issues regarding this lapse of service.

     Day to Day Turnovers
   While classes are in session, every effort is to be made by the members to provide a quick
   response. This is to be done by having as many regular scheduled crews a possible and by
   communication among the members regarding their absences and outside commitments.

   In cases where a crew is not available, the call will be turned over for mutual aid. This will
   be done by Rensselaer County Dispatch.


   If a member does not acknowledge the call within 1 minute, a crew cannot be confirmed
   within 2 minutes, or the ambulance is not enroute within 3 minutes, the call will
   automatically be turned over to mutual aid. All times are counted from the time of initial
   dispatch of the ambulance.

   In the case of a non-emergency transport from the RPI Student Health Center, the nurse or
   doctor may choose to wait longer to try to raise a crew.

   In the case of a large incident, the dispatcher will signify so and will continue trying to raise
   a crew for as long as feasible.

     Extended Periods of Absence
   If the ambulance will out of service for a scheduled period of time (such as maintenance) all
   members should be notified ahead of time (such as by email) and the Public Safety
   dispatcher should be notified by phone of the absence of service. This ensures that no time is
   wasted trying to raise an ambulance for a patient on campus when it is not available to
   respond.

   If the ambulance will be out service, for any period of time, the Rensselaer County
   Dispatcher should also be notified of the absence so that RPI Ambulance is not called for any
   calls during that period of time.

   Any time the ambulance is taken out of service, an “Out-of-Service” sticker should placed
   over the NYS-DOH certification sticker.




Matthew Willett, Captain                                                                   54 of 62
RPI Ambulance Standard Operating Procedures                                    30 November 2010
    SOP 10-25 Patient Transport Destinations
     Introduction
   Patients are usually transported to the hospitals in Rensselaer, Albany, or Schenectady
   Counties. The only exception to this may occur when RPI Ambulance has responded to a
   mutual aid request and the usual receiving hospital(s) of the agency requesting mutual aid is
   substantially closer than one of the facilities in Rensselaer, Albany, or Schenectady Counties.

   The hospital destination, within the areas of Rensselaer, Albany, or Schenectady Counties,
   will depend on a variety of factors, including, but not limited to, patient medical condition,
   patient request, road and weather conditions, location of the patient’s regular physician, and
   location of the incident. Under no circumstances will the a patient be transported to a hospital
   that is more than 20 minutes further distance than the nearest hospital according to the NYS
   BLS Protocols.

   Any patient deemed to be in an immediately life-threatening situation will be taken to the
   nearest appropriate hospital.

     Unusual Receiving Facility
   In an emergent situation, if a patient seeks transportation to a hospital outside the area to
   which the RPI Ambulance ordinarily transports patients, the patient will be informed of the
   RPI Ambulance receiving hospitals, the distances involved, and that no exceptions are made.
   If the patient refuses transportation, the “Refusal of Transportation” policy will be followed.
   The members will inform the patient of the possible medical consequences of his/her action,
   and have the patient sign a refusal of transportation statement.

   If the situation is non-emergent and the patient or caller makes inquiry (e.g. the need to
   transport a non-ambulatory stable patient), they shall be referred to the Empire Ambulance
   Service or Mohawk Ambulance Service.

     Receiving Facility on Diversion
   If crew gives a hospital as patient destination and the medical control physician at that
   receiving hospital feels that patient condition warrants transport to the nearest facility, the
   crew will inform the patient and any accompanying relative, and comply immediately with
   the medical control order. If once the patient is enroute to a certain hospital and that hospital
   medical control orders the ambulance to divert to another hospital, the crew will inform the
   patient and will do everything in their power to explain the reasons for the diversion. If the
   patient is alert, oriented and understands the reason for diversion but still refuses diversion
   from the hospital of choice; s/he will be asked to sign a refusal and will be taken to the
   original hospital destination. If, however, in the opinion of the highest trained member in
   attendance, the patient’s request of hospital will cause further harm to the patient, the nearest
   appropriate hospital will be used. In all cases of diversion from the patient’s hospital choice,
   the EMT will record the patient’s request on the Prehospital Care Report and the reasons for
   transporting to the closest appropriate hospital.



Matthew Willett, Captain                                                                   55 of 62
RPI Ambulance Standard Operating Procedures                                    30 November 2010
   If a receiving hospital diverts the ambulance to another receiving hospital because of
   emergency room conditions as opposed to patient condition, the ambulance will divert if, in
   the judgment of the crewmember with the highest level of training, in consultation with
   medical control, it is determined that the patient condition is stable enough to warrant
   diversion. Under these circumstances the patient, whose condition is stable, is informed that
   the hospital has requested diversion for the reason stated. If the patient insists that s/he be
   taken to the originally requested hospital and the crew is unable to persuade the patient
   otherwise, the patient’s hospital destination choice will be honored by the crew and the
   hospital informed of the reason that the ambulance will not honor their request for diversion.
   Generally, patients who are critical or unstable must be taken to the nearest facility.

      Hospital Destination in Mutual Aid Situation
   In a mutual aid situation, if a hospital is substantially closer than the usual receiving
   hospitals, that hospital will be utilized. If communication with dispatch and/or the receiving
   hospital is impaired, a real possibility in some mutual aid instances, the crew will utilize all
   BLS and ALS standing orders as appropriate, and then follow the regional communication
   difficulty protocol. The destination hospital will be contacted as soon as possible, either by
   radio or by cellular telephone.

   If in a mutual aid situation, in the rare instance the crew may be transporting a patient to a
   hospital other than RPI Ambulance usual receiving hospitals, if a diversion is requested, the
   crew will divert only if the diversion does not in any way, in the judgment of the highest
   trained crew member, compromise the patient.

      Transport and Hospital Destination of Major Trauma Patients
   In a major trauma situation, where the crew deems appropriate, the nearest air medical
   service – helicopter (Usually Albany Med Flight or Lifeguard) will be requested. The crew
   will generally meet the helicopter at a mutually agreeable landing zone enroute to the
   hospital. Arrangements will be made through dispatch for the establishment of the landing
   zone by the appropriate Fire Department.

   If Air Medical Service is not available, in almost all instances the nearest hospital is the
   appropriate receiving facility. In the rare instance that the crew may be working in an area on
   a mutual aid request, the crew chief should keep in mind that Albany Medical Center is a
   designated trauma center, and may be the appropriate destination for patients meeting major
   trauma criteria as found the NYS BLS Protocols.




Matthew Willett, Captain                                                                  56 of 62
RPI Ambulance Standard Operating Procedures                                    30 November 2010
    SOP 10-26 Miscellaneous
     Introduction
   Several aspects of EMS require policies that do not fit well into the other categories. These
   are included in this section. The separate section is not to imply any greater or lesser
   importance of these policies.

     Locating Patients
   If the ambulance responds to a call and there is no patient found, the crew will work with
   appropriate first response and law enforcement agencies (on campus, TFD and DPS
   respectively). to complete a search of the area. After a proper search or when released by the
   appropriate law enforcement agency, the ambulance may call in service and clear the scene.
   The PCR will document the search and included all applicable information.

   In performing the search for a patient, RPI Ambulance members will not force entry into any
   location. They may enter a Residence Hall using their access card, but may not open the
   door to a room unless accompanied by the patient, a friend, a roommate, a Resident Assistant
   or Associate, or a DPS officer. One exception occurs if the crew can see inside the room,
   locate the patient, confirm the patient is in need of care, and that there are no hazards in the
   room. See also hazardous scenes later in this policy.

     Special Patients
       Minors
       Unless legally emancipated, minors are not allowed to refuse care or transport. At the
       same time, RPI Ambulance cannot kidnap the minor to the hospital. In some cases, DPS
       will take custody of the child until a parent can be found. . If the minor is refusing
       treatment and/or transport and the crew feels that the minor is in need of such
       care/transport, DPS will be contacted immediately. If the child runs away, the crew
       should not endanger themselves by following the child.

       In the case of a public function covered by RPI Ambulance, a minor does not need to be
       signed off if no care was rendered. I.e., all the crew did was hand the child a band-aid or
       a cold pack.

       Emotionally Disturbed Persons
       As a general rule, RPI Ambulance does not transport patients to a psychiatric facility
       because of mental health problems unless the patient also has a medical problem
       requiring ambulance transportation. If a call is received for a patient with an unknown
       problem or history who is showing signs of unusual behavior (possible psychiatric
       problem), the crew will proceed to the scene, evaluate the patient with an eye toward
       possible medical causes for the behavior, and transport the patient to an appropriate
       facility. In this type of unknown situation, it is strongly suggested that the crew request
       assistance from law enforcement. Patients with behavioral problems should always be
       treated with respect while protecting their welfare. In such a situation, it is strongly
       suggested that the patient care crew consist of at least two persons, one of whom is the
       same sex as the patient. If at any time, a patient is a potential harm to the crew or

Matthew Willett, Captain                                                                  57 of 62
RPI Ambulance Standard Operating Procedures                          30 November 2010
      themselves, a law enforcement officer should be utilized for protect; only a law
      enforcement officer is able to restrain a patient.

     Crimes
   Suspicions of crimes should be reported by the Crew Chief to the law enforcement officer on
   scene (usually DPS). The crew should not deal with the crime directly. The purpose of EMS
   is to help those in need not to chase down the criminals.

   In the case of abuse (child, patient, elder, or other domestic violence), notification should be
   made to the officer on scene and to the receiving nurse. The Crew Chief should carefully
   document the scene and all physical findings. The PCR is not the place to make accusations
   but should remain an objective assessment of the situation.

     Incident Reporting
   An Incident Report should be completed whenever there is an occurrence that, in the
   member’s opinion, is sufficiently unusual to merit special attention and should be reported.
   All incident reports shall be reviewed as soon as possible by the most senior officer available
   and shall be referred to the QI Committee for review.

   An incident report must be completed in the following circumstance. In addition, the
   reviewing officer is responsible for documenting the incident and any corrective action taken
   on the form designated by the RPI Ambulance for that purpose.
        Unexpected EMS vehicle and patient care equipment failure that could have resulted
           in harm to a patient.

   The following incidents must be immediately reported to the Captain or, in his/her absence,
   the next highest ranking officer; must be thoroughly documented on an incident report and
   must be reported to the NYS Department of Health Bureau of Emergency Medical Services,
   by telephone, the following day, and in writing, within five (5) working days:

          Any member of the service is killed or injured to the extent requiring hospitalization
           or care by a physician while on duty.
          Patient care equipment fails while in use, causing patient harm.
          A patient dies, is injured, or is otherwise harmed due to actions of commission or
           omission by a member of the ambulance service.
          An EMS vehicle operated by the service is involved in a motor vehicle crash in which
           a patient, member of the crew, or other person is killed or injured to the extent
           requiring hospitalization or care by a physician.
          It is alleged that any member of the service has responded to an incident or treated a
           patient while under the influence of alcohol or drugs.

     Obvious and Unattended Death
   When called to a patient who is in cardiac arrest, the ambulance crew will begin resuscitation
   (including defibrillation) and transport the patient as appropriate unless one of the following
   conditions exists:

Matthew Willett, Captain                                                                  58 of 62
RPI Ambulance Standard Operating Procedures                                30 November 2010
       Crew is presented with a valid “Nonhospital Order Not to Resuscitate (DOH-3473)
       The patient is found to be wearing a “Do Not Resuscitate” bracelet
       The patient is found to be obviously dead by showing one of more of the following
         conditions:
          Obviously mortal injury
          Extreme dependent lividity
          Rigor mortis
          Tissue decomposition

   In each of the above situations, it is imperative that the EMT evaluate the patient’s
   respirations and carotid pulse (brachial pulse in infants) to assure that they are absent. The
   ambulance crew is not to rely on the reports of bystanders, law enforcement personnel, etc. in
   regard to the absence of a pulse or “death” of a patient. Furthermore, if CPR is withheld in
   any of the above situations, the condition which led the crew to withhold CPR must be
   documented on the PCR. If there is any doubt as to whether to start resuscitation, begin BLS
   care including defibrillation and contact medical control (either through Re/MAC or
   individual hospitals) for direction.

   A “health care proxy” or “living will” may not be used in a prehospital EMS situation to
   determine that resuscitation measures, including CPR, can be withheld. In a situation where
   there is no Nonhospital Order Not to Resuscitate and the patient does not meet any of the
   other above listed criteria for obvious death, resuscitation measures should be started and the
   patient transported unless, upon consultation with medical control, the medical control
   physician advises otherwise. Any legal papers regarding a living will or health care proxy
   should be taken to the hospital by the ambulance crew and given to the hospital staff.

   If the deceased person is a hospice patient with a valid Nonhospital Order Not to Resuscitate,
   the EMT should attempt to contact the hospice worker on call and be guided by his/her
   advice. Hospice will generally contact the patient’s physician who will sign the death
   certificate, and the presence of the coroner is generally not necessary in this situation.

   In other situations where there is a death where the patient meets the above guidelines for
   “obvious death”, the crew will be guided by the following:
        Contact Rensselaer County Bureau of Public Safety to request law enforcement
          assistance.
        Remain at the scene until the arrival of the police.

   In general, bodies of the deceased are not to be transported. In a situation where the patient
   is obviously dead and is in a public place, the crew may, at their discretion, transport the
   body a short distance to remove it from public view, but only on the advice of and request
   from the coroner.
   If, as a result of their observations at the scene of a cardiac arrest or unattended death, the
   crew suspects an attempted suicide, suicide, or other criminal activity has been involved, the
   crew will make every reasonable attempt to preserve evidence while providing whatever
   patient assessment, care, and/or transportation is necessary.

Matthew Willett, Captain                                                                 59 of 62
RPI Ambulance Standard Operating Procedures                                   30 November 2010
     Child Abuse and Maltreatment
   NY State EMTs are considered mandatory reporters of Child abuse and Maltreatment per §
   413 of the Social Services Law. The law requires EMTs to report suspected child abuse they
   come across while performing their jobs.

   § 415 of the Social Services Law states: “Reports of suspected child abuse or maltreatment
   made pursuant to this title shall be made immediately by telephone or by telephone facsimile
   machine on a form supplied by the commissioner. Oral reports shall be followed by a report
   in writing within forty-eight hours after such oral report. Oral reports shall be made to the
   statewide central register of child abuse and maltreatment unless the appropriate local plan
   for the provision of child protective services provides that oral reports should be made to the
   local child protective service”

   Oral reports of suspected child abuse and maltreatment shall be made by calling the NYS
   Child Abuse and Maltreatment Register at 1-800-635-1522. This phone number is for
   mandatory reporters only and shall not be distributed to the general public.

   All oral reports shall be followed up in writing using Form DSS-2221-A available from the
   duty supervisor. A copy of the completed form shall be attached to the copy of the PCR
   retained by the agency.

   Definitions of suspected child abuse and maltreatment, as well as guidelines for filling a
   report, are available from the duty supervisor. All EMTs should familiarize themselves with
   these definitions and the guidelines for filing a report.

   The EMT should make hospital staff at the receiving facility aware of his/her suspicions
   during the oral report to the nurse when patient care is transferred.

   The PCR should include documentation of the EMT’s suspicions and documentation that the
   required reporting was met.

   Immunity from liability for reporting cases of suspected child abuse or maltreatment is
   provided to those individuals required to report such cases under §419 of the Social Services
   Law providing the individual was acting in ‘good faith’.

   §420 of the Social Services law states:
      1. Any person, official or institution required by this title to report a case of suspected
          child abuse or maltreatment who willfully fails to do so shall be guilty of a class A
          misdemeanor.
      2. Any person, official or institution required by this title to report a case of suspected
          child abuse or maltreatment who knowingly and willfully fails to do so shall be
          civilly liable for damages proximately caused by such failure.




Matthew Willett, Captain                                                                 60 of 62
RPI Ambulance Standard Operating Procedures                                    30 November 2010
     Geriatric or Other Patient Abuse/Maltreatment
   Geriatric abuse and neglect, and other domestic violence, like child abuse and neglect, is a
   big problem in our society. The primary sign is unexplained injuries in an elderly or other
   patient. In the situation where the crew suspects abuse or neglect of any patient, they should
   complete a full patient assessment, including a scene assessment, and report their suspicions
   to the Emergency Department staff.

          If the patient refuses transportation, and is deemed mentally capable of making an
           informed decision in that regard, the crew should report the situation and their
           suspicions to the RPI DPS and Troy Police Department as soon as reasonably able
           and document their objective findings on the PCR.

     Abandoned Infant
   The Abandoned Infant Protection Act of 2000 allows a parent, guardian, or other legally
   responsible person to leave their infant (who must be five days old or younger) at a safe
   place. This safe place may include an ambulance station.

   In the event that a parent or guardian chooses to relinquish care of their newborn infant to the
   RPI Ambulance, the following guidelines should be followed:
       1. Parents are not required to provide their names. In a non-judgmental manner, the
           EMS provider receiving the infant may ask the adult if there is any medical
           information that is important to know in the care of the infant.
       2. The EMS provider receiving the infant at the station must immediately call the
           Rensselaer County dispatcher who in turn will put out a call for the duty crew. The
           infant will be assessed by the crew, cared for according to protocol, as needed, and be
           transported immediately via ambulance to the nearest hospital. A PCR will be
           completed for the run in the usual manner.
       3. If, at any time, the parent or guardian seeks follow-up information about the child
           they relinquished, they should be referred to the hospital where the infant was
           transported.




Matthew Willett, Captain                                                                  61 of 62
RPI Ambulance Standard Operating Procedures                           30 November 2010
    SOP 10-27 Approval/Review Document
   We the undersigned have reviewed the policies contained herein (SOP 10-00 through SOP
   10-27) and find it to be satisfactory policy for RPI Ambulance.




Matthew Willett
Captain, RPI Ambulance




Leslie Lawrence, MD
Medical Advisor, RPI Ambulance




Matthew Willett, Captain                                                        62 of 62

				
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